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Blood, Vol. 95 No. 1 (January 1), 2000:
pp. 78-82
Outpatient penile aspiration and epinephrine irrigation for young
patients with sickle cell anemia and prolonged priapism
Elpis Mantadakis,
David H. Ewalt,
Joe Don Cavender,
Zora R. Rogers, and
George R. Buchanan
From the Division of Hematology-Oncology, Department of Pediatrics
and Department of Urology, The University of Texas Southwestern Medical
Center at Dallas and Children's Medical Center, Dallas, Texas.
The optimal management of prolonged priapism for patients with
sickle cell anemia (SCA) has not been established. We prospectively studied in an outpatient setting the efficacy and safety of a procedure
that employs aspiration of blood from the corpora cavernosa and
irrigation with a dilute epinephrine solution under local anesthesia to
relieve priapism in young patients with SCA. If hydration and
analgesics failed to produce detumescence or if priapism had lasted
>4 hours, the protocol was activated in the emergency room or clinic.
Fifteen patients with homozygous SCA (Hb SS) were treated on 39 occasions; 10 patients were treated once, 1 patient twice, 2 patients 3 times, 1 patient 6 times, and 1 patient 15 times. Median age of
patients at first treatment was 14.3 years (range, 3.9-18.3 years). The
procedure was successful in producing immediate detumescence on 37 of
39 occasions (95% efficacy, 95% confidence intervals
(CI): 81%-99%). No serious immediate or long-term side effects were
observed. None of the patients who demonstrated detumescence required
hospitalization. The 2 patients whose priapism persisted after
aspiration and irrigation presented with episodes lasting >24 hours.
All evaluable patients whose priapism resolved after aspiration and
irrigation self-reported normal erectile function at a median of 40 months (range, 3-58 months) after the last procedure. Thus, aspiration
of the corpora cavernosa followed by irrigation with dilute epinephrine
is effective in producing immediate and sustained detumescence and
should be the initial therapy employed for patients with SCA and
prolonged priapism. (Blood, 2000; 95:78-82)
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