Urology

Question 1

Priapism - pH cut-off for ischaemic vs non-ischaemic

Answer 1

pH 7.25
< = Ischaemic
> = Non-ischaemic

Cavernosal gas analysis

Question 2

Priapism treatment: non-ischaemic

Answer 2

Does not require emergent treatment!

Ice and compression
Embolisation or surgery considered in conservative therapy fails

Aspiration + intracorporeal adrenaline not indicated

Question 3

Priapism treatment: ischaemic

Answer 3

Analgesia
Early urology consult
Treat underlying conditions e.g. sickle cell crisis

Aspiration + adrenergic therapy
- Doral penile nerve block
- 19-21G needle into corpora laterally (abundant communication)
- Aspirate 20-30mL blood -> blood gas analysis
- Irrigate with saline 10mL aliquots (controversial)
- Administer intracorporeal vasoconstrictor every 5 min e.g. adrenaline 1-2mL 1:100,000 (10-20mcg), max 100mcg or 10mL OR phenylepherine 0.1-0.5mL diluted in 10mL normal saline