A 28-year-old man presents with a painful erection lasting 7 hours unrelated to sexual arousal. Aspiration of corpus cavernosum blood shows pO2 below 30 mm Hg, pCO2 elevated and pH 6.9. After analgesia and hydration, what is the first-line intervention?
- A Immediate penile prosthesis implantation
- B Corporal aspiration and irrigation with intracavernosal phenylephrine ✓
- C Oral sildenafil daily
- D Distal shunt surgery as first-line therapy
Correct answer: B. Corporal aspiration and irrigation with intracavernosal phenylephrine
Explanation
Ischaemic (low-flow) priapism is confirmed by the acidic, hypoxic cavernosal blood gas. Beyond 4 hours it is a compartment syndrome of the penis and needs prompt detumescence by corporal aspiration with saline irrigation plus intracavernosal phenylephrine, escalating to surgical shunts only if this fails. Sildenafil worsens ischaemic priapism and is contraindicated. Penile prosthesis is reserved for established erectile dysfunction after delayed presentation, and shunts are second line after failure of aspiration and sympathomimetics.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.