Pain control: Morphine and/or penile nerve block
Running in place or doing squats can potentially achieve detumescence
Follow a step-wise approach:
1. Aspirate 25mL of blood from cavernosum, up to two times
2. Irrigate cavernosum with 25mL of cold (10°C) saline
3. Medication injections
Ensure procedure is appropriate
Rarely beneficial after 48h
Risk of impotence is high even with treatment
Obtain consent
Prep the area with chlorhexidine and drape appropriately
Penile nerve block or local anesthesic at puncture site
Insert 18 gauge needle into penile shaft at 2 and 10 o'clock positions (or 3 and 9 o'clock positions)
Aspirate blood (usually 20 - 30 cc on each side)
May follow with intracavernosal injections (most common is phenylephrine)
Rarely beneficial after 48h
Risk of impotence is high even with treatment
Dose: 0.25-0.5mg SQ in deltoids OR 5-10mg PO, may repeat in q20min
Dilute phenylephrine 1ml of 1mg/ml in 9mL NS for final concentration of 100mcg/mL
For 500 mcg/ml, take 0.5 ml of 10mg/ml phenylephrine, and dilute in 9.5 cc NS
Inject base of penis with 19-Ga needle (after blood aspiration to confirm position)
100-200 mcg every 3-5min (max 1000 mcg) until resolution or 1 hour
Ensure patient fully monitored, with BP, HR, pulse oximetry
Reflex bradycardia is expected, so consider dosages relative to toleration of drop from baseline HR
Only one side needs to be injected since there exists a vascular channel between the 2 corpora cavernosa
Compress injection area to prevent hematoma formation
Use with caution in cardiovascular disease
For 500 mcg/ml, take 0.5 ml of 10mg/ml phenylephrine, and dilute in 9.5 cc NS
100-200 mcg every 3-5min (max 1000 mcg) until resolution or 1 hour
Reflex bradycardia is expected, so consider dosages relative to toleration of drop from baseline HR
Only one side needs to be injected since there exists a vascular channel between the 2 corpora cavernosa
In pediatric population, intracavernosal injection of epinephrine instead of phenylephrine has been shown more successful in achieving detumescence
Wrap penis in elastic bandage after detumescence is achieved
Emergent urology consult for possible shunt procedure (can often be done in ED)
May resolve with observation
Consult urology for consideration of surgical correction or embolization by interventional radiology
IV hydration
Pain control
Supplemental oxygen
Transfusion for goal HCT>30% with consultation for partial exchange transfusion (HGB-S<30%)
Exchange transfusion is associated with ASPEN syndrome (Association of Sickle cell<unk> , Exchange transfusion & Neurological events)
Urology consult
Exchange transfusion is associated with ASPEN syndrome (Association of Sickle cell<unk> , Exchange transfusion & Neurological events)
Priapism
Peyronie's Disease
Urinary incontinence
Urethral foreign body
Dysgeusia
Penile surgical implant
Ataxia
Erection from sexual arousal