Although specific regimens for corporal aspiration and irrigation differ, one commonly used at our institution to treat an ischemic priapism is as follows: After a penile block is applied, a dilute solution of phenylephrine is prepared by adding 1 mL of phenylephrine
(10 mg/mL) to 99 mL of normal saline for a final concentration of 100 μg/mL. A 19-gauge butterfly needle is then inserted into the lateral aspect of one Inhibitors,research,lifescience,medical of the Ganetespib Phase 3 corpora cavernosa, and 1 or 2 mL of solution (ie, 100–200 μg of phenylephrine) is injected intracavernosally. If detumescence is not apparent within 2 minutes, an additional 1 or 2 mL of the phenylephrine solution is injected. This is repeated at 2-minute intervals until detumescence is achieved, with no more than 10 mL of total solution injected (ie, 1000 Inhibitors,research,lifescience,medical μg of phenylephrine). If detumescence does not occur with phenylephrine, the cavernosa should be irrigated with normal saline, with or without the addition of heparin. If there is difficulty aspirating the irrigate, a second 19-gauge butterfly needle can be placed on the opposite side of the Inhibitors,research,lifescience,medical shaft away from the first butterfly needle. To facilitate involvement of the entire cavernosa, 1 needle should be placed proximally with the contralateral needle placed distally. With regard to priapism that is secondary to an underlying systemic disorder, such as sickle cell disease and other hematologic malignancies, intracavernosal intervention should proceed concurrently
with systemic treatment. For example, for the patient in Case 1, data suggest that systemic measures alone (ie, hydration, oxygenation, blood exchange transfusions, analgesia, and alkalinization) have reduced efficacy when compared with concomitant systemic and cavernosal therapies.1 Surgical Interventions Distal shunts In the event that Inhibitors,research,lifescience,medical aspiration/irrigation with the use of a sympathomimetic
agent fails, additional surgical intervention may be required. The next step involves the creation of a shunt distally between the corpora cavernosa and the glans of the penis. The distinct venous drainage of the corpora spongiosum (and its distal continuation, the glans penis) and the corpora cavernosa allows Inhibitors,research,lifescience,medical the congested cavernosa to drain. A number of different types of shunts have been described, including the Ebbehøj, Winter’s, and Al-Ghorab. The Ebbehøj shunt involves insertion Batimastat of a scalpel through the glans penis lateral to the meatus into the underlying distal end of one or both of the rigid corpora cavernosa.13 The Winter’s shunt involves the same maneuver, however, with a large biopsy needle substituted for the scalpel.14 Finally, the Al-Ghorab shunt involves a transverse incision into the glans between the corona and superior aspect of the urethral meatus, with the incision carried down to excise the tunica albuginea off the tip of the corpora cavernosa.15 A summary of the efficacy and reported postintervention impotence as compiled by the AUA Guideline Panel is reported in Table 2.