A 12 year old patient with sickle cell disease presents to the ED with painful erection x 5 hours.   Urology is paged and suggests fluids, high flow oxygen, compresses to the area and exchange transfusion.

They do not wish to aspirate blood from the penis in a patient this young, as they state that repeated aspirations over this young man’s lifetime could cause scarring and impotence.  Should you go forward with their recommended management?

Priapism

 

No.  Aspiration of blood from the corpus cavernosa is the first line treatment for low-flow priapism lasting longer than 4 hours.  Exchange transfusion is a second line treatment for priapism refractory to aspiration.  While scarring and impotence are feared complications, they are believed to be as likely to result from untreated priapism as they are from the aspiration itself.

Perform a ring block of the penis first.

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Then aspiration should be performed from both sides as shown.

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Send the aspirated blood for blood gas to confirm low flow (venous) priapism.  Once confirmed, sympathomimetic drugs (such as phenylephrine) may be injected if priapism persists.  All of this should be done in close consult with your urology colleagues.