Treating priapism

Treatment for priapism will depend onthe type of priapism you have.

High blood flow (non-ischaemic) priapism may not need treatment.A fewcasesget better on their own aftera few hours.

If you have injured your genital area, and youhavea painful and persistent erection, seek immediate medical assistance from your nearest accident and emergency (A&E) department .If its not treated within 24 hours you may have difficulties getting an erection in the future.

You may need surgery to temporarily prevent the flow of blood into your penis (see below).

If you are diagnosed with low blood flow (ischaemic) priapism,or have an episode of recurrent (stuttering) priapism, aspiration or sympathomimetic injections may be recommended.

The aim when treating recurrent priapism is to prevent further episodes.

Aspiration

Aspiration is the first treatment recommended for priapism.

Your penis is numbed with a Local anaesthetic anda small needle and syringe is used to drain blood from your penis.

In some cases, the blood vessels may bewashed out with sterile water to get ridofany debris. This is known as irrigation.

Aspiration and irrigation usually help relieve painful symptoms and may result in your erection subsiding. However, you may needa number of treatment sessions before this happens.

Sympathomimetic injections

If your symptoms do notrespond to aspiration, the next step is to inject a type of medication known as a sympathomimetic directly into the tissue of your penis.

Sympathomimetics work by squeezing the blood vessels in your penis, helping them push blood out of your penis while also preventingmore blood from being pumped in.

A type of sympathomimetic called phenylephrine is usually recommended because it has a lower risk of causing side effects compared with other sympathomimetics.

Side effects of phenylephrine include:

• an increase in blood pressure, which can make you feel dizzy and lightheaded
• headache
• rapid or irregular heartbeat

If you have a health condition that could be made worse by an increase in blood pressure, such as heart disease , you will needregular blood pressure checksand electrocardiograms (ECGs). An ECG measures your heart'selectrical activity.

Surgery

Surgery may be recommended if your symptoms fail to respond to aspiration or sympathomimetic injections. There are several surgical procedures available, depending on the type of priapism you have.

If you have ischaemic priapism, shunt surgery may be recommended. It involves creating a new route for blood to flow out of the penis.

This surgery is only effective if performed within a few hours of the development of the priapism, so it is important that you attend hospital quickly.

A small number of menwho have surgery for priapism experience erectile dysfunction afterwards. The risk is greater where the priapism has lasted a long time.

If you experience erectile dysfunction after surgery for priapism, you may need further surgery to treat it. It aims to stop the flow of blood into your penis by inserting a small device to block the damaged artery.

Medicines for recurrent (stuttering) priapism

The most commonly used medicines are:

• gonadotrophin-releasing hormone (GnRH) agonists or antagonists
• antiandrogens such as flutamide or bicalutamide