A 55-Year-Old Man Comes to the Emergency Department Due to a Painful

question 1068

Multiple Choice

A 55-year-old man comes to the emergency department due to a painful, persistent erection.  Earlier in the evening, the patient used an intracavernosal injection of alprostadil to achieve an erection for sexual intercourse.  His erection persisted afterward but he was able to fall asleep.  He was then awakened 4 hours later due to pain in his penis.  The patient placed an ice pack over the region, but the painful erection remained.  He does not have a history of genitourinary trauma or similar episodes in the past.  Medical history is notable for type 2 diabetes mellitus and peripheral vascular disease.  Current medications include lisinopril, metformin, rosuvastatin, and low-dose aspirin.  The patient does not use tobacco, alcohol, or illicit drugs.  Temperature is 37 C (98.6 F) , blood pressure is 120/78 mm Hg, pulse is 88/min, and respirations are 14/min.  The corpora cavernosa of the penis are engorged and tender to palpation.  The glans and the corpus spongiosum are softly distended without rigidity.  There are no genital lesions, urethral discharge, or evidence of trauma.  Cavernosal blood gas analysis shows pH of 7.2, pCO₂ of 65 mm Hg, and pO₂ of 30 mm Hg, consistent with ischemic priapism.  Corporeal aspiration is attempted but fails to relieve the patient's symptoms.  Which of the following is the best next step in the management of this patient's condition?

• A)Angiographic embolization
• B)Doppler ultrasonography
• C)Intracavernosal phenylephrine injection
• D)Intravenous fluids and supplemental oxygen
• E)Reassurance that this will likely resolve spontaneously

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