A 26-year-old man presents with a 6-hour history of painful rigid erection. He has sickle cell disease. Corporal blood gas shows pO2 below 30 mmHg. After corporal aspiration, which agent is given intracavernosally first line?
- A Phenylephrine ✓
- B Papaverine
- C Alprostadil
- D Atropine
Correct answer: A. Phenylephrine
Explanation
The low corporal pO2 confirms ischaemic (low flow) priapism, the common type in sickle cell disease and a urological emergency beyond 4 hours because of risk of fibrosis and permanent erectile dysfunction. After needle aspiration of old dark blood, intracavernosal phenylephrine, an alpha agonist that causes corporal smooth muscle contraction, is first line therapy. Alprostadil and papaverine cause erection and would worsen the condition. Refractory cases need distal shunt procedures such as Winter or Al-Ghorab.
Reference: Smith and Tanagho's General Urology, 19th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.