Sickle cell disease: priapism: aspiration and epinephrine irrigation lead to successful detumescence.

Clinical bottom line (level 4)

  1. 95% of boys with sickle cell disease and priapism who have aspiration of the corpus cavernosum and irrigation with diluate epinephrine go onto to have successful detumescence.
Mantadakis et al: Blood 2000; 95 ( 1 ): 78-82
Expires March 2004

The study

Case series with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: emergency department, children's hospital, USA

15 patients (aged 4 to 18; median 14, 100% male) with sickle cell disease and 39 episodes of priapism lasting longer than 2 hours not responding to simple methods such as iv hydration and parenteral morphine.
Corpus carvernosum aspiration using a 23G needle, three-way tap and syringe following a local anaesthetic injection. Following aspiration of as much blood as possible, the corpus cavernosum was irrigated with 10 ml of a 1: 1 000 000 solution of epinephrine (1 ml of 1: 1000 solution in 1L normal saline). After withdrawal firm pressure was applied for 5 minutes to prevent haematoma formation. The patient was discharged home if there was sustained detumescence 30 minutes after the procedure.

100% followed for hospital stay
Outcomes studied:
  • detumescence

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    detumescence hospital stay 37/39 95%
    (81% to 99%)

    Comments

    1. No patient with successful detumescence required hospital admission.
    2. It is unclear whether aspiration alone is sufficent or the addition of epinephrine is necessary.

    Citation

    1. Mantadakis E, Ewalt DH, Cavender JD, et al: outpatient penile aspiration and epinephrine irrigation for young patients with sickle cell anaemia and prolonged priapism. Blood 2000; 95 ( 1 ): 78-82
    Search Terms: sickle and priapsim in Clinical Queries section of PubMed
    Contributor: Chris Ball, March 2001
    Reviewer:

    Clinical Question.
    Patient sickle cell disease and priapism
    Intervention or Exposure aspiration of corpus cavernosum and irrigation with epinephrine
    Outcome detumescence
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