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Priapism Medication

  • Author: Hosam S Al-Qudah, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Oct 30, 2015
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to restore sexual function. Drugs used include adrenergic agonists and antidotes.

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Adrenergic Agonists

Class Summary

These agents have been used successfully in the treatment of priapism, possibly due to their sympathomimetic vasopressor activity.

Terbutaline has been shown to be effective for the treatment and prevention of priapism, although its mechanism of action in these cases is not yet fully elucidated.

Phenylephrine

 

Phenylephrine is a strong postsynaptic alpha-receptor stimulant with little beta-adrenergic activity that produces vasoconstriction of arterioles in the body. This agent increases peripheral venous return. The drug is best administered in a dilute solution; add 10 mg (usually 1 mL) of phenylephrine to 499 mL of normal saline, yielding a solution with 20 mcg/mL.

Pseudoephedrine (Sudafed, ElixSure, Unifed, Psudatabs)

 

An oral dose of 60-120 mg may be given in cases of priapism of short duration (2-4 h). Pseudoephedrine promotes vasoconstriction by directly stimulating alpha-adrenergic receptors.

Terbutaline

 

Terbutaline is a selective beta2-adrenergic agonist used successfully in the treatment of priapism.

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Antidotes

Class Summary

These agents have a second-messenger inhibitory effect, affecting muscle relaxation.

Methylene blue

 

Methylene blue inhibits smooth muscle relaxation.

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Contributor Information and Disclosures
Author

Hosam S Al-Qudah, MD Consultant Urologist and Transplant Surgeon, Division of Urology, Department of General Surgery, Saad Specialist Hospital, Saudi Arabia

Disclosure: Nothing to disclose.

Coauthor(s)

Monica Parraga-Marquez, MD Consulting Staff, Department of Emergency Medicine, Metropolitan Hospital Center; Clinical Assistant Professor, Department of Emergency Medicine, New York Medical College

Monica Parraga-Marquez, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Richard A Santucci, MD, FACS Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, Societe Internationale d'Urologie (International Society of Urology), American Urological Association

Disclosure: Nothing to disclose.

Osama Al-Omar, MD Director of Pediatric Urology, Assistant Professor of Surgery, Department of Urology, West Virginia University School of Medicine

Osama Al-Omar, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Urological Association, Michigan State Medical Society, National Arab American Medical Association, Society for Fetal Urology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS Program Director, Assistant Professor, Department of Emergency Medicine, University of Arkansas for Medical Sciences

Martin J Carey, MD, MB, BCh, MPH, FACEM, FRCS is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, British Medical Association, and Fellowship of the Australasian College for Emergency Medicine

Disclosure: Nothing to disclose.

Colin M Dougherty, MD Staff Physician, Department of Emergency Medicine, Tri-City Medical Center; Staff Physician, Department of Emergency Medicine, Kaiser-Permanente, San Diego Medical Center/Kaiser Foundation Hospital

Colin M Dougherty, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Lance W Kreplick, MD, FAAEM, MMM Medical Director of Hyperbaric Medicine, Fawcett Wound Management and Hyperbaric Medicine; Consulting Staff in Occupational Health and Rehabilitation, Company Care Occupational Health Services; President and Chief Executive Officer, QED Medical Solutions, LLC

Lance W Kreplick, MD, FAAEM, MMM, is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physician Executives

Disclosure: Nothing to disclose.

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

M Tyson Pillow, MD, MEd Associate Residency Director, Section of Emergency Medicine, Ben Taub General Hospital; Assistant Professor, Director of Simulation Program, Office of Undergraduate Medical Education, Baylor College of Medicine

M Tyson Pillow, MD, MEd is a member of the following medical societies: Air Medical Physician Association, American College of Emergency Physicians, American Medical Association, American Medical Student Association/Foundation, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Student National Medical Association

Disclosure: Nothing to disclose.

Allison J Richard, MD Assistant Professor of Emergency Medicine, Keck School of Medicine of the University of Southern California; Associate Director, Division of International Medicine, Attending Physician, Department of Emergency Medicine, LAC+USC Medical Center

Disclosure: Nothing to disclose.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Paul S Wahlheim, MD Staff Physician, Department of Emergency Medicine, St Joseph's Hospital and Medical Center

Paul S Wahlheim, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

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Priapism. Corporeal relaxation causes external pressure on the emissary veins exiting the tunica albuginea, trapping blood in the penis and causing erection.
Priapism. Sexual stimulation causes the release of nitric oxide (NO) via stimulation of nonadrenergic noncholinergic neurons. NO-activated intracellular guanylate cyclase, converting guanosine triphosphate (GTP) to cyclic guanosine monophosphate (cGMP), causes relaxation of cavernosal arteries and increased penile blood flow, resulting in erection.
Priapism. Winter shunt placed by biopsy needle, usually under local anesthetic.
Priapism. Proximal cavernosal-spongiosum shunt (Quackel shunt) surgically connects the proximal corpora cavernosa to the corpora spongiosum.
Priapism. Proximal cavernosal-saphenous shunt (Grayhack shunt) surgically connects the proximal corpora cavernosum to the saphenous vein.
 
 
 
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