Treatment for Low-Flow Priapism

[txterp98]

Hey guys, I asked a question on here a few months back and just wanted to say thanks for everyone who helped out. I found your input really useful.

I was wondering if some of the residents/attendings/fellows out there could assist me in the expected ER treatment of low-flow priapism. I'm a community ER attending and I was wondering what possible measures you'd expect before getting called in. Here's what I've done in the past...

1) IV analgesia, NS hydration, supplemental O2
2) Terbutaline 0.25mg SQ; repeated dose in 15-30min if no improvement
3) Pseudoephedrine 60mg PO

Unfortunately, that's about it. I'm willing to perform an intra-cavernosal aspiration/irrigation with NS, but I can't find any material online as to the correct way to do the procedure. If you guys could point me in the right direction to a website with pictures, a good procedure book, or a description here, I'd be really appreciative. I suppose push-came-to-shove if working in a rural community with no urologist available for hours necessitating a transfer, I'd even try intercavernosal phenylephrine. Once again, I'd need to know a website/procedure book or a good description to lock away in my palm pilot if ever needed.

Thanks for your time, guys. Just trying to learn a bit more and making sure I've done all that I can beforehand rather than diagnose/turf the patient without a reasonable effort.

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[gudog]

Go to auanet.org and look at the guideline for priapism.

You don't have to be able to log in to see it.

Very detailed info, with supporting literature.

 

[SLUser11]

I was wondering if some of the residents/attendings/fellows out there could assist me in the expected ER treatment of low-flow priapism.

Picture of Oprah in a bikini......


Sorry, I was drawn in by the title and don't have any actual input that isn't immature and only kind of funny.....

If you guys could point me in the right direction to a website with pictures....

Now I just can't respond to that.....I don't do layups......

 

[NHL Fever]

Hey guys, I asked a question on here a few months back and just wanted to say thanks for everyone who helped out. I found your input really useful.

I was wondering if some of the residents/attendings/fellows out there could assist me in the expected ER treatment of low-flow priapism. I'm a community ER attending and I was wondering what possible measures you'd expect before getting called in. Here's what I've done in the past...

1) IV analgesia, NS hydration, supplemental O2
2) Terbutaline 0.25mg SQ; repeated dose in 15-30min if no improvement
3) Pseudoephedrine 60mg PO

Unfortunately, that's about it. I'm willing to perform an intra-cavernosal aspiration/irrigation with NS, but I can't find any material online as to the correct way to do the procedure. If you guys could point me in the right direction to a website with pictures, a good procedure book, or a description here, I'd be really appreciative. I suppose push-came-to-shove if working in a rural community with no urologist available for hours necessitating a transfer, I'd even try intercavernosal phenylephrine. Once again, I'd need to know a website/procedure book or a good description to lock away in my palm pilot if ever needed.

Thanks for your time, guys. Just trying to learn a bit more and making sure I've done all that I can beforehand rather than diagnose/turf the patient without a reasonable effort.

When I see a priapism, because there is only so much time you can wait I usually go directly to aspiration/injection if the patient agrees. Use a butterfly needle because you only need one poke that way. I jab the butterfly into the side of the corpora from the side or somewhat obliquely, in a place where it will be near the center or one of the corpora, and not near the urethra. Then I get a 20 or 30 cc syringe and suck through the butterfly tubing as much blood as will come - usually 10-15 cc, then inject 5 or so cc saline or water back in, for irrigation. Then I usually aspirate it out again, then switch syringes to a smaller one for 100 micrograms of phenlyephrine to inject into the corpora, followed by enough saline to flush the line. Wait 3-5 min. You almost always see some response. If not complete, repeat starting at aspirating blood again. You can repeat this many times, but do it with the patient on a monitor because of the effects of phenylephrine which some can have bad reactions to. One guy I injected 8 times, most it will work with 1 or 2.

Oh and before doing it, you can perform a penile block which involves injecting 5 cc of 2% lidocaine on either side of the dorsal vein of the penis in the space between the pubic symphysis and the corpora. Its a difficult block to do, most anesthesia residents have never even tried one so no help there. If it doesn't work which is often the case, at least most patients can bear the pain.