All the advertisements for erectile dysfunction medications suggest that four hours of priapism requires emergent care, but neither the Physicians’ Desk Reference nor the detailer can tell me what that entails. A 10-year-old textbook suggests drainage with a large-bore syringe/needles. Do you have any better suggestions?
—Charles W. Patterson, MD, Yuma, Ariz.

Drug-induced priapism is much more common with self-injection treatment for sexual dysfunction than with oral remedies. Nevertheless, an erection lasting four hours, usually painful, is a urologic emergency. First-line medical treatment uses a mixture of 1 cc of phenylephrine (10 mg/cc) and 19 cc of normal saline. Begin by placing a 21-g butterfly needle in the corpora and aspirating 10-15 cc of blood. Inject 10 cc of the solution. Wait five minutes, and repeat until detumescence is achieved. The patient must be on a cardiac monitor during this procedure. More difficult cases may require surgery. For additional information, see Campbell’s Urology. 8th ed. (Walsh PC, Retik AB, Vaughan ED Jr, et al, eds. Philadelphia, Pa.: WB Saunders: 2002:1662).
—David T. Noyes, MD (113-21)

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