A 22-year-old man with sickle cell disease has had a painful rigid erection for 7 hours. Aspiration of corpora cavernosa blood yields dark deoxygenated blood with low pH. Initial corporal aspiration has failed to achieve detumescence. What is the next step in management?
- A Intracavernosal phenylephrine followed by distal shunt surgery if refractory ✓
- B Intracavernosal injection of alprostadil
- C Immediate insertion of a penile prosthesis
- D Oral sildenafil and reassurance
Correct answer: A. Intracavernosal phenylephrine followed by distal shunt surgery if refractory
Explanation
Ischaemic priapism beyond 4 hours is a urological emergency. After failed aspiration, intracavernosal phenylephrine, an alpha agonist causing corporal smooth muscle contraction, is given, and refractory cases need a surgical shunt such as a Winter or Al-Ghorab procedure to restore outflow. Alprostadil worsens ischaemic priapism, and prosthesis insertion is reserved for established erectile dysfunction after delayed presentation.
Reference: Smith's General Urology, 18th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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