Introduction

Acute ischemic priapism is considered a medical emergency, and prompt intervention is indicated to prevent potentially permanent erectile dysfunction (ED) and corporal fibrosis. Guidelines recommend using a stepwise approach to manage acute ischemic priapism, which includes corporal aspiration, irrigation, and intracavernous injection of sympathomimetic agents. At our institution, we treat a large number of patients for acute priapism. We sought to evaluate if large doses of phenylephrine (PE) resulted in any significant changes in vital signs or impacted outcomes.

Methods

After IRB approval, we retrospectively reviewed the charts of patients presenting to our emergency department between May 1, 2014 and August 15, 2016 using ICD9 and ICD10 diagnosis codes for priapism. Baseline variables were explored with categorical data analysis (Chi-Squared and T-tests). Where feasible, linear regression was used to evaluate outcomes.

Results

We identified 74 different patient encounters of acute priapism. 58 patients received PE during the course of their management. Of this group, the median age was 36.5 years (IQR = 27-47) and the median time to presentation was 5.4 hours (IQR = 4.0-9.6). 31 patients had previously experienced priapism. The median dose of PE given was 1,000 mcg (IQR 500-2,000). Univariate regression found no association between PE dose and change in patient heart rate or blood pressure. Even when considering patients who received a higher dose (greater than the median of 1,000 mcg), phenylephrine did not have a statistically significant effect on patient vital signs (see Figure). 53 of 58 (91%) patients receiving PE experienced detumescence, 2 required shunting in operating room, and 2 refused treatment and left against medical advice.

Conclusions

We frequently treat patients with high doses of PE and seldom notice adverse effects, typically resulting in resolution of priapism without any additional procedures. Careful administration of high-dose intracavernosal PE in patients presenting with priapism does not appear to affect hemodynamic stability and may help avoid ischemic damage and achieve detumescence effectively and efficiently.

Funding

None.