A 40-year-old man presents with a 6-hour history of painful rigid erection following intracavernosal alprostadil injection. Corporal blood gas shows pO2 below 30 mmHg. After corporal aspiration and saline irrigation fail to detumesce, the next step is:
- A Intracavernosal injection of phenylephrine ✓
- B Distal shunt surgery
- C Immediate penile prosthesis implantation
- D Oral sildenafil and observation
Correct answer: A. Intracavernosal injection of phenylephrine
Explanation
The low corporal pO2 confirms ischaemic priapism, a urological emergency. The standard stepwise approach is corporal aspiration with irrigation, followed by intracavernosal sympathomimetic phenylephrine before any surgical intervention. Shunts such as the Winter or Al-Ghorab procedure are reserved for failure of conservative measures. Sildenafil is contraindicated in ischaemic priapism, and prosthesis implantation is considered only for established fibrosis from neglected episodes.
Reference: Campbell-Walsh Urology, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.