Priapism Reduction

This video demonstrates a dorsal penile nerve block followed by techniques for reducing a priapism. Dorsal penile nerve block is also covered in a separate video. Briefly, inject 1-2 mL of lidocaine or bupivacaine without epinephrine at the base of the penis at 10:00 and 2:00. Remember to prep the skin with antiseptic solution and aspirate before injecting.

For the priapism reduction, first prep the shaft of the penis with antiseptic solution. once adequately anesthetized, insert an 18-21 gauge needle into the shaft of the penis into the corpus cavernosum on either side (the right and left side communicate) and aspirate the blood. Obtain a blood gas sample to confirm the diagnosis of ischemic priapism vs nonischemic. The expected blood gas results in ischemic priapism include PO2 <30 mm Hg, pCO2 >60 mm Hg, and pH <7.25. Continue to aspirate blood. Manual compression (milking or massage of the shaft) may be needed to break up blood clots. Use a diluted phenylephrine solution at a concentration of 100 micrograms/mL. Inject aliquots of 100 micrograms every 5 minutes in combination with aspiration, to a maximum of 1,000 micrograms. As the procedure progresses the aspirated blood will change from dark red to bright red. The goal is detumescence.