A 26-year-old man with sickle cell disease presents with a painful rigid erection of eight hours' duration. Corporal blood gas shows a low pH and low pO2. Aspiration of dark blood from the corpora confirms ischaemic priapism. After adequate local anaesthesia and hydration, what is the correct first-line intervention?
- A Corporal aspiration and irrigation followed by intracavernosal injection of a sympathomimetic agent ✓
- B Immediate insertion of a Winter cavernoglanular shunt
- C Oral pseudoephedrine and observation for 24 hours
- D Intracavernosal injection of alprostadil
Correct answer: A. Corporal aspiration and irrigation followed by intracavernosal injection of a sympathomimetic agent
Explanation
Ischaemic priapism beyond four hours is an emergency because smooth muscle hypoxia leads to fibrosis and permanent erectile dysfunction. Stepwise first-line treatment is corporal aspiration of the dark deoxygenated blood, saline irrigation, then intracavernosal injection of a sympathomimetic such as phenylephrine. Shunt surgery is reserved for failure of these measures. Oral agents and observation delay definitive care, and alprostadil induces erections and would worsen the condition.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.