Inspired by the procedural skills of Dr.’s Lazarciuc, Milliner, and Rajpal…

In brief, step by-by-step:

  1. Sterile field
  2. Dorsal penile nerve block: 2 cc of Lidocaine w/o Epi injected close to penile base, from 2 and 10 o’clock aimed toward center of shaft.
  3. penile block
  4. Insert 19-gauge needle at 2 (and if needed, 10) o’clock. Can also use butterfly connected to syringe.
  5. Aspirate blood gas to confirm ischemic vs non-ischemic priapism (though this should be evident from H&P or darker-tinged venous blood).
  6. Aspirate using 20 cc syringe; repeat as needed. Can also leave needle in place and manually squeeze penis to extrude blood.
  7. If needed (i.e. blood clotting from prolonged symptom duration), place another needle proximally for normal saline syringe irrigation.
  8. As needed (and if without contraindications), put patient on monitor and inject 1 mL Phenylephrine 100 mcg/mL (pre-mixed here at Sinai) q3-5 min for 1 hr until symptom resolution. The alpha agonist activity contracts smooth muscle and permits venous outflow.
  9. Call Urology for shunt surgery if no detumescence by 1 hr. Specifically, a fistula is created between the corpus cavernosum and spongiosum, glans penis, or one of the penile veins.
  10. Do not forget to compress needle sites after their removal to avoid hematoma formation.