A 26-year-old man presents with 6 hours of a painful, rigid erection following an injection for erectile dysfunction. Aspiration of corporal blood shows a pH of 6.8. After initial corporal aspiration and saline irrigation, which drug should be given intracavernosally?
- A Phenylephrine ✓
- B Alprostadil
- C Papaverine
- D Sildenafil
Correct answer: A. Phenylephrine
Explanation
This is ischaemic (low flow) priapism, confirmed by the acidic corporal blood. After aspiration and irrigation, an intracavernosal alpha agonist such as phenylephrine is given to cause smooth muscle contraction and detumescence, with monitoring for hypertension. Papaverine and alprostadil are erectogenic agents and would worsen the condition. Sildenafil has no role in acute ischaemic priapism; refractory cases need surgical shunts because fibrosis begins after about 48 hours.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.