A 19-year-old man with sickle cell disease presents with a painful rigid erection of 6 hours duration unrelieved by ejaculation. Corporal blood gas shows low pH, low pO2 and high pCO2. After intracavernosal injection fails to achieve detumescence, what is the appropriate next step?
- A Oral pseudoephedrine and discharge home
- B Immediate penile prosthesis insertion
- C Corporal aspiration followed by intracavernosal phenylephrine ✓
- D Distal shunt surgery as first-line intervention
Correct answer: C. Corporal aspiration followed by intracavernosal phenylephrine
Explanation
This is ischaemic (low-flow) priapism, confirmed by the acidic hypoxic corporal blood gas, and it is a urological emergency because fibrosis and permanent erectile dysfunction begin after 4 hours. First-line treatment is corporal aspiration of old blood followed by intracavernosal phenylephrine. Shunt surgery is reserved for failure of these measures, not used first. Oral sympathomimetics are inadequate beyond 4 hours, and prosthesis insertion is only considered later for established erectile dysfunction.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.