How is low-flow priapism treated?

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

Treatment should progress in a stepwise fashion, accompanied by supportive care and the identification and treatment of reversible causes. Intracavernosal phenylephrine is the drug of choice and first-line treatment of low-flow priapism because the drug has almost pure alpha-agonist effects and minimal beta activity. In short-term priapism (< 6 h), especially drug-induced cases, intracavernosal injection of phenylephrine alone may result in detumescence.

Some studies suggest that oral terbutaline orally, at a dose of 5-10 mg, followed by another 5-10 mg 15 minutes later, if required, produces resolution in about one third of patients. Oral pseudoephedrine, 60-120 mg orally has also been suggested as a potential therapy due to its alpha-agonist effect. The exact efficacy of this medication orally is unknown. Oral agents may be a reasonable treatment option to use while preparing for aspiration/injection. If no resolution occurs within 30 minutes, injection therapy is required.

Similarly, evidence supporting noninvasive treatment of ischemic priapism is sparse, but attempting it poses minimal risk as long as it does not delay the use of more definitive treatment. Conservative treatments described in the literature include application of an ice pack, cold showers, masturbation, and lower-limb exercise (eg, stair climbing). [23]


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