A 17-year-old boy with sickle cell anaemia presents with a fully rigid, severely painful erection of 6 hours duration. Corporal blood gas shows low pH, low pO2 and high pCO2. After analgesia and hydration, what is the immediate next step in management?
- A Oral phosphodiesterase-5 inhibitor to relax smooth muscle
- B Immediate cavernoglanular shunt surgery
- C Corporal aspiration with intracavernosal phenylephrine injection ✓
- D Observation for spontaneous detumescence within 24 hours
Correct answer: C. Corporal aspiration with intracavernosal phenylephrine injection
Explanation
This is ischaemic priapism beyond 4 hours, confirmed by the hypoxic acidic corporal blood gas. First-line treatment is corporal aspiration followed by intracavernosal sympathomimetic phenylephrine, with repeated dosing as needed. Shunt surgery is reserved for failure of these measures, since early shunting risks permanent erectile dysfunction. PDE-5 inhibitors worsen arterial inflow and are used only in non-ischaemic priapism. Waiting risks irreversible smooth muscle necrosis and fibrosis.
Reference: Campbell-Walsh Urology, 12th ed.
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Written and medically reviewed by the StethoPrep medical team.