A 35-year-old man with sickle cell disease presents with a painful erection of 6 hours duration that began during sleep. Examination shows a rigid erection involving both corpora cavernosa with a flaccid glans. Doppler ultrasound shows absent cavernosal arterial flow. After initial analgesia and hydration, what is the definitive first-line intervention?

• A Intracavernosal injection of papaverine
• B Corporal aspiration and irrigation with intracavernosal phenylephrine ✓
• C Immediate insertion of a penile prosthesis
• D Oral phosphodiesterase-5 inhibitor

Explanation

Ischaemic (low-flow) priapism is confirmed by absent cavernosal flow on Doppler and a rigid shaft with flaccid glans. It is a urological emergency because detumescence beyond 4 to 6 hours risks permanent erectile dysfunction from corporal smooth muscle necrosis. First-line treatment after supportive care is corporal blood aspiration followed by intracavernosal sympathomimetic phenylephrine. Papaverine worsens priapism since it is vasodilatory, a PDE5 inhibitor is contraindicated, and surgery (shunt procedures or prosthesis) is reserved for refractory cases.

Reference: Campbell-Walsh Urology, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.