A 16-year-old boy with HbSS presents with a fully rigid, painful erection of five hours duration. Intravenous fluids and opioid analgesia have been given. What is the next definitive step?

• A Oral sildenafil and discharge with follow-up
• B Immediate penile prosthesis implantation
• C Corporal blood aspiration with intracavernosal phenylephrine injection ✓
• D Ice packs and observation for spontaneous detumescence

Explanation

Priapism lasting over four hours in sickle cell disease is a urological emergency because cavernosal ischemia leads to fibrosis and permanent erectile dysfunction. After supportive care fails to detumesce promptly, corporal aspiration followed by intracavernosal injection of a sympathomimetic such as phenylephrine is the accepted next step. Exchange transfusion is considered for refractory cases. Sildenafil promotes erection and is inappropriate, prostheses are a late option for established fibrosis, and observation risks irreversible ischemic injury.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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