Priapism treatment generally involves a systematic process to attempt to alleviate the pressure caused by inadequate blood circulation out of the penis. Treatment may begin with noninvasive measures and progress to surgical intervention if necessary. Medical intervention and priapism resolution may evolve around contributing factors. Treatment modality may also vary whether the problem is arterial or venous in nature.
Non-invasive priapism treatment generally involves ice applied to the penis and the perineum. The extremely cold temperature typically reduces swelling by constricting blood vessels. Narrowing the vessels not only inhibits blood from entering the penis, but also forces blood out of the area. Leg movement, in the form of walking up and down a flight of stairs, for example, may enhance blood circulation and promote drainage from the engorged area. Anyone experiencing an erection lasting four or more hours should seek medical intervention.
Low flow, or venous engorgement might occur from excess erectile dysfunction medication, illegal drugs or alcohol consumption. These substances generally cause blood vessel dilation, contributing to ongoing engorgement. Physicians may reverse the effects of vasodilation by injecting the cavernous region with a vasoconstricting medication. Patients might receive phenylephrine injections to reduce penile swelling caused specifically by vasodilation.
Cancer, sickle cell anemia and other circulatory disorders may contribute to low flow priapism. Especially with sickle cell involvement, treatment not only involves resolving penile swelling, but also usually requires extensive medical intervention. Circulatory issues produced by abnormal sickle cells typically affect multiple systems. Patients may require oxygenation and hydration, along with blood transfusions to improve circulation.
Blood pooled in one area for an extended period has a tendency to develop fibrous clots, further complicating circulation. Priapism treatment may include imaging studies if causes cannot readily be determined. An angiography with media contrast or doppler sonogram generally confirms whether vessel occlusion is a contributing factor. These studies typically indicate if a blockage exists, identify the location of the vessel, and determine whether the affected vessel is arterial or venous in nature.
Emergency room staff might use a combination of irrigation and aspiration as priapism treatment. After injecting a local anesthetic, physicians may inject saline solution into the corpus cavernosum or into a penile vein. The physician then generally aspirates or removes this fluid. Flushing an area with fluid and subsequently extracting the fluid may loosen blockages, allowing blood to flow out of the penis.
Patients may require surgical intervention as priapism treatment if other methods fail, or injury caused internal trauma. Surgeons may correct high flow arterial involvement, secondary to injury, by tying off the torn artery. Physicians might also insert shunts to redirect blood flow.