ALTERNATIVE APPROACHES TO THE MANAGEMENT OF PRIAPISM

Herein we describe the use of intracavernous methylene blue (MB), a gu anylate cyclase inhibitor, or internal pudendal artery embolization fo r the treatment of priapism. Eleven patients with priapism were treate d from 1993-1996. Etiologies of priapism included PGE(1)/papaverine (3 ), trazodone (2), and sickle cell disease (1), in the other five cases the cause was unknown. The average duration of priapism was 27 h for all patients (6-72 h). Five patients who failed intracavernous MB or a n alpha-adrenergic agonist, underwent unilateral or bilateral pudendal artery embolization. The average duration of priapism for patients un dergoing embolization was 43 h. Sixty-seven percent of the patients tr eated with MB responded with immediate detumescence. One-hundred perce nt of patients with priapism secondary to intracavernous injection the rapy or trazodone responded. Of the five patients who underwent emboli zation, 40% achieved immediate pain relief and subsequent detumescence . The three non-responders exhibited a partial detumescence over 47-72 h. After follow-up of one year embolization available for only two pa tients revealed that one regained potency while the other remained imp otent. These results confirmed that MB is effective for pharmacologica lly-induced priapism. Embolization is a less invasive option for refra ctory priapism, although results are less than satisfactory in men wit h priapism of several days duration.