Priapism with intracavernosal alprostadil

An erection lasting 4-6 hours is a medical emergency - in this situation the patient should attend the local accident and emergency department to avoid damage to the intracavernous muscle and blood vessels which could result in permanent ED

• patients should be advised initially to take light exercise such as going up and down stairs
• if the prolonged erection persists, a 19-gauge butterfly needle should be inserted into the corpora cavernosa to aspirate blood and thereby decrease intracavernous pressure
• further improvements can be gained by ‘washing out’ the corpora by injecting in saline and then withdrawing the saline and blood together
• if this is not effective or if the penis becomes rigid again, phenylephrine or adrenaline injection may be effective

A lower dose of alprostadil should be used for any subsequent injections (1)

Reference:

• (1) Hackett G et al. British Society for Sexual Medicine guidelines on the management of erectile dysfunction. J Sex Med. 2008;5(8):1841-65.