Editing Priapism (section)

==Treatment==

Medical evaluation is recommended for erections that last for longer than four hours. Pain can often be reduced with a [[dorsal penile nerve]] block or penile [[ring block]].<ref name=EM2017/> For those with nonischemic priapism, cold packs and pressure to the area may be sufficient.<ref name=EM2017/>

===Pseudoephedrine===

Orally administered [[pseudoephedrine]] is a first-line treatment for priapism.<ref>{{cite web|title=Priapism (An Erection that Lasts Too Long)|url=https://www.mskcc.org/cancer-care/patient-education/priapism|website=mskcc.org|access-date=22 July 2021|language=en}}</ref> Erection is largely a parasympathetic response, so the sympathetic action of pseudoephedrine may serve to relieve this condition. Pseudoephedrine is an [[alpha-agonist]] agent that exerts a constriction effect on smooth muscle of corpora cavernosum, which in turn facilitates venous outflow. Pseudoephedrine is no longer available in some countries.

===Aspiration===
For those with ischemic priapism, the initial treatment is typically [[Suction (medicine)|aspiration]] of blood from the [[Corpus cavernosum penis|corpus cavernosum]].<ref name=EM2017/> This is done on either side.<ref name=EM2017/> If this is not sufficiently effective, then cold [[normal saline]] may be injected and removed.<ref name=EM2017/>

===Medications===
If aspiration is not sufficient, a small dose of [[phenylephrine]] may be injected into the corpus cavernosum.<ref name=EM2017/> Side effects of phenylephrine may include: [[hypertension|high blood pressure]], [[bradycardia|slow heart rate]], and [[Heart arrhythmia|arrhythmia]].<ref name=EM2017/> If this medication is used, it is recommended that people be monitored for at least an hour after.<ref name=EM2017/> For those with recurrent ischemic priapism, [[diethylstilbestrol]] (DES) or [[terbutaline]] may be tried.<ref name=EM2017/>

===Surgery===
Distal shunts, such as the [[George D. Winter|Winter's]],{{clarify|date=November 2009}} involve puncturing the glans (the distal part of the penis) into one of the cavernosa, where the old, stagnant blood is held. This causes the blood to leave the penis and return to the circulation. This procedure can be performed by a urologist at the bedside. Winter's shunts are often the first invasive technique used, especially in hematologically induced priapism, as it is relatively simple and repeatable.<ref>{{cite journal |vauthors=Macaluso JN, Sullivan JW | title = Priapism: A review of 34 cases | journal = Urology | volume = 26 | pages = 233–236 | year = 1985 | doi = 10.1016/0090-4295(85)90116-5 | pmid = 4035837 | issue = 3 }}</ref>

Proximal shunts, such as the Quackel's,{{clarify|date=November 2009}} are more involved and entail operative dissection in the [[perineum]] where the corpora meet the spongiosum while making an incision in both and suturing both openings together.<ref>{{cite journal |vauthors=Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, Nehra A, Sharlip ID | title = American Urological Association guideline on the management of priapism | journal = [[J. Urol.]] | volume = 170 | issue = 4 Pt 1 | pages = 1318–24 |date=October 2003 | pmid = 14501756 | doi = 10.1097/01.ju.0000087608.07371.ca }}</ref> Shunts created between the corpora cavernosa and [[great saphenous vein]] called a Grayhack shunt can be done though this technique is rarely used.<ref>{{Cite journal |last1=Bassett |first1=Jeffrey |last2=Rajfer |first2=Jacob |date=Winter 2010 |title=Diagnostic and Therapeutic Options for the Management of Ischemic and Nonischemic Priapism |journal=Reviews in Urology |language=en |volume=12 |issue=1 |pages=56–63 |pmid=20428295|pmc=2859143 }}</ref>

As the complication rates with prolonged priapism are high, early [[Penile implant|penile prosthesis]] implantation may be considered.<ref name=EM2017/> As well as allowing early resumption of sexual activity, early implantation can avoid the formation of dense fibrosis and, hence, a shortened penis.

===Sickle cell anemia===
In sickle cell anemia, treatment is initially with [[intravenous fluids]], [[pain medication]], and [[oxygen therapy]].<ref name=NIH2014/><ref name=EM2017/> The typical treatment of priapism may be carried out as well.<ref name=EM2017/> [[Blood transfusions]] are not usually recommended as part of the initial treatment, but if other treatments are not effective, [[exchange transfusion]] may be done.<ref name=NIH2014>{{cite book|title=Evidence Based Management of Sickle Cell Disease|date=2014|publisher=NHLBI|pages=39–40|url=https://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/sickle-cell-disease-report.pdf|archive-url=https://web.archive.org/web/20170125155233/https://www.nhlbi.nih.gov/sites/www.nhlbi.nih.gov/files/sickle-cell-disease-report.pdf|archive-date=2017-01-25|access-date=2017-03-07}}</ref><ref name=EM2017/>