Priapism is a medical emergency that requires immediate treatment to optimize patient outcomes and avoid costly litigation. This kit, designed by urologists specializing in male sexual dysfunction, provides all the essential equipment and detailed step-by-step instructions for the immediate treatment of priapism by any medical professional.

Dr. John Mulhall discusses management of priapism using the Priapism Kit from UroSciences.

What is priapism?
Priapism is a medical emergency in which an erection persists for more than 4 hours. In most cases, the penis becomes painfully engorged with blood due to fatigue or failure of penile smooth muscle, which normally regulates the flow of blood into the penis. Pressure within the erectile bodies (corpora cavernosa) climbs and eventually exceeds systolic blood pressure, which prevents arterial oxygenated blood from entering the penis (ischemic priapism). Immediate penile decompression is necessary to restore perfusion and avoid permanent damage to the erectile tissues of the penis. Failure to promptly identify and treat priapism can result in permanent erectile dysfunction or penile deformity.

How is priapism treated?
The goals of priapism treatment are to provide immediate relief of penile pain and to prevent permanent penile dysfunction by restoring the flow of oxygenated, arterial blood to the penis as quickly as possible. This may be accomplished in several ways. Drugs (phenylephrine) may be injected directly into the corpora cavernosa to stimulate contraction of penile smooth muscle. The corpora cavernosa can be decompressed and irrigated with a large-bore needle. In some cases, particularly when treatment is delayed, the penile smooth muscle may become unresponsive to medication. In these cases, surgery by an appropriate specialist may be required. When treatment is very delayed, immediate implantation of a penile prosthesis may be the only option.

Advantages of the Priapism Kit
The success and ease of priapism treatment depend upon the duration of priapism. Delays in priapism treatment once a patient has presented to a healthcare facility result in the need for more invasive treatments and increase the risk of permanent penile dysfunction. Failure to provide prompt treatment may result in legal liability.

Treatment of priapism may be delayed for several reasons. Many healthcare providers are not familiar with priapism treatment and subspecialists are not always immediately accessible. Even when an experienced healthcare provider is available, the time it takes to find and prepare the requisite equipment and medication for treatment may also cause significant delay.

The Priapism Kit was designed by urologists specialized in sexual dysfunction to empower any healthcare provider to treat priapism. The kit contains detailed, easy to follow step-by-step instructions for the treatment of priapism. All equipment required for treatment is included and clearly labeled for ease of use. Time wasted waiting for subspecialist consultants to arrive or searching for equipment is eliminated. The results are improved patient outcomes and more cost-efficient emergency room care.

The Priapism Kit is comprised of:

Sterile fenestrated drape (18 x 26″). Place the drape over the field to cover the area around the genitals. This protects the patient from possible spillage of blood and allows the provider to rest instruments on the drape while maintaining sterility.

1 mL syringe with 27G x 0.5″ needle. An initial attempt at quick detumescence can be made by drawing up phenylephrine solution (not included) and injecting into the base of the penis. If the attempt is successful, then there is no need to aspirate blood clots or perform other maneuvers.

16 G 1″ needle, alcohol prep, 5 mL syringe. Use the 16 G needle with the 3 mL syringe to aspirate an appropriate volume of phenylephrine 1% (not included) from the vial in standard sterile fashion. The phenylephrine must be diluted with an appropriate volume of sterile injectable normal saline (not included) to achieve recommended concentrations from 100 mcg/mL – 1000 mcg/mL. The alcohol prep is used to wipe the vial tops. For short duration priapism (4-6 hours), 200 to 500 mcg of phenylephrine can be administered directly into the corpora cavernosa every 3 to 5 minutes for up to one hour.

27G x 1.25″ needle, 10 mL syringe. For an optional nerve block, the 16G needle can be used with the 10 mL syringe to withdraw lidocaine 1% (not included). The needle is then changed to the smaller 27G 1.25″ needle to administer a dorsal penile block or penile ring block by infiltrating the 10 mL of lidocaine.

10 mL normal saline flushes (2), 19 G butterfly, 3-way port, and 20 mL syringe. For priapism > 6 hours, corporal irrigation and aspiration may be used along with phenylephrine injection. The 3 mL syringe with diluted phenylephrine, one 10 mL saline flush syringe, and the butterfly syringe are each connected to the 3-way port. Once the butterfly needle is inserted into the corpora cavernosa, the 3-way port is adjusted so that saline flush irrigation can be alternated with the phenylephrine administration. The 20 mL syringe is exchanged with the 10 mL flush in order to aspirate blood.

Emesis basin (500 mL). The basin is used as a convenient receptacle for aspirated blood and blood clots during the procedure.

Cohesive bandage 1″ and 4 x 4: gauze 2-pack (3). Gauze is used during the procedure, bandages are used to absorb blood and to compress injection sites to prevent bruising and swelling. At the conclusion of the procedure, the penis is often edematous. Place a gauze bandage around the penis and apply a loose cohesive bandage over the gauze to limit post-procedural swelling and bruising.