A 30-year-old man with sickle cell disease presents with a painful rigid erection of seven hours duration. Corporal aspirate shows dark deoxygenated blood with low pO2. Aspiration and intracavernosal phenylephrine fail to achieve detumescence. What is the next step in management?

• A Continue repeated phenylephrine injections for 24 hours
• B Corporoglanular shunt (Winter procedure) ✓
• C Exchange transfusion alone
• D Immediate penile prosthesis implantation

Explanation

This is low-flow (ischaemic) priapism, confirmed by the dark acidic corporal blood. First-line therapy is corporal aspiration combined with intracavernosal phenylephrine. When this fails after several hours of ischaemia, a distal corporoglanular shunt such as the Winter or Al-Ghorab procedure is performed to create a fistula allowing venous drainage. Prolonged ischaemia beyond 24 hours risks irreversible fibrosis and erectile dysfunction, so waiting longer is harmful, and prosthesis insertion is deferred until late fibrotic complications develop.

Reference: Campbell-Walsh-Wein Urology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.