A 32-year-old man presents with a 6-hour history of painful rigid erection unrelated to sexual activity. Penile Doppler shows absent cavernosal arterial flow. Aspiration of corporal blood shows dark blood with pO2 below 30 mmHg. What is the immediate next step in management?
- A Immediate penile prosthesis insertion
- B Corporal irrigation with saline followed by intracavernosal phenylephrine injection ✓
- C Oral sildenafil and reassessment in 12 hours
- D High-flow ice packs and observation alone
Correct answer: B. Corporal irrigation with saline followed by intracavernosal phenylephrine injection
Explanation
This is ischaemic (low-flow) priapism, confirmed by absent flow on Doppler and hypoxic corporal blood gas. It is a urological emergency because smooth muscle necrosis begins around 4 hours and fibrosis causes permanent erectile dysfunction if untreated beyond 24 to 48 hours. First-line treatment is corporal blood aspiration with irrigation and intracavernosal phenylephrine. Sildenafil worsens the condition, and shunt surgery or prosthesis is reserved for failure of these measures.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.