Priapism toolbox: facilitating emergency management of ischaemic priapism and improving safety of intracavernosal phenylephrine use

• Published in: Journal of sexual medicine Vol. 19; no. 11; pp. S93 - S94
• Main Authors: Shin, Dr. Je Song, Bradley, Dr. Caroline, Jones, Dr. Jennifer, Rewhorn, Dr. Matthew, Vint, Dr. Ross, Fraser, Dr. Michael
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-11-2022
• ISSN: 1743-6095; 1743-6109
• DOI: 10.1016/j.jsxm.2022.10.054

Priapism is a rare urological emergency. Ischaemic priapism (IP) is the commonest type and prolonged IP poses a significant risk of smooth muscle necrosis in the corpus cavernosum which can lead to sequelae of corporal fibrosis and erectile dysfunction. Urgent intervention to achieve rapid detumescence is therefore important to mitigate poor functional outcomes. We set out to identify key areas for improvement in patient care relating to the initial assessment and management of IP.
We carried out a questionnaire amongst urology trainees in our large teaching hospital on their experience of managing IP. Detailed feedback on practical hurdles of managing IP was also collected. The European Association of Urology (EAU) and the British Association of Urological Surgeons (BAUS) guidelines were consulted to formulate a ‘checklist’ for use in our department.
Junior trainees had no prior experience of managing IP and lacked familiarity with guidelines. Senior trainees had prior experience but 80% reported problems managing refractory IP in an acute setting such as the emergency department due to difficulties locating suitable equipment and drugs. Phenylephrine was most commonly used intracavernosal agent and all respondents identified vasopressor dosage calculation as potential patient safety concern. 80% also agreed a ‘checklist’ would be helpful to standardise practice. Based on the feedback and recommendations from available guidelines, we instigated a ‘priapism toolbox’ which contains a step-by-step guide and all the consumables needed for managing IP at the patient bedside. Toolbox also includes a 3-way stopcock for ‘spill-proof’ cavernosal aspiration and instillation, lidocaine, 1% phenylephrine and patient information leaflets on penile shunting/implant.
A checklist guiding stepwise management of IP and a ‘toolbox’ to facilitate early bedside intervention can ensure high standards of care in these rare emergencies. A checklist is also useful in highlighting patient safety checks and threshold for treatment escalation in refractory IP.
The authors declare that there is no conflict of interest.