What is the step-wise approach to the treatment of low-flow priapism?

Updated: Dec 26, 2019
  • Author: Osama Al-Omar, MD, MBA, FACS, FEBU; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Low-flow priapism (ischemic)

Treatment should progress in a stepwise fashion, involving supportive care and the identification and treatment of reversible causes. Intracavernosal phenylephrine is the drug of choice and first-line treatment for low-flow priapism because it has almost pure alpha-agonist effects and minimal beta activity.

Following pharmacologic therapy, the next step in the treatment of low-flow priapism is aspiration of the corpora cavernosa followed by saline irrigation and, if necessary, injection of an alpha-adrenergic agonist (eg, phenylephrine).

If the aforementioned interventions are unsuccessful, a diluted solution of phenylephrine may be used for irrigation. If medical treatment fails, the condition warrants surgical intervention.

Key steps in the management of low-flow priapism caused by SCD include the following:

  • Oxygenation
  • Analgesics (eg, intravenous morphine)
  • Hydration
  • Alkalization
  • Exchange transfusions
  • Emergent surgical decompression: Advocated by most experts when conservative management fails

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