Methylene blue as a successful treatment alternative for pharmacologicallyinduced priapism

Objective: Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation. Etiologies of this condition are numerous . Treatment of priapism varies from a conservative medical to a drastic sur gical approach. Recent findings indicate methylene blue (MB), a guanylate c yclase inhibitor, to be a potential inhibitor of endothelial-mediated caver nous relaxation. This prompted us to assess the feasibility, use and effect iveness of MB in the treatment of priapism. Methods: 12 patients were treated for priapism. Etiologies were: 10 drug-me diated (PGE(1) or papaverine/phentolamine mixture) after corpus cavernosum injection therapy (CCIT); 1 leukemia-induced, and 1 idiopathic high-flow pr iapism. The age range for all patients was 13-67 years, the average duratio n of priapism was 5.5 h after CCIT. MB was administered after blood aspirat ion of the corpora cavernosa. 5 ml of MB was injected intracavernously (i.c .) and left for 5 min. MB was then aspirated and the penis compressed for a n additional 5 min. Results: All patients with CCIT-induced priapism were cured with MB alone. The 2 patients who did not respond to MB underwent i.c. phenylephrine admin istration and embolization of the pudendal artery, respectively. The etiolo gy and duration of priapism were the strongest predictors for success with i.c. administered MB. The primary side effects were a transient burning sen sation and blue discoloration of the penis on injection of MB. The initial baseline erectile status was restored in all patients cured by MB. Conclusion: These results confirm that MB is a safe and highly effective tr eatment agent for short-term pharmacologically induced priapism. The applic ation of MB shows virtually no significant side effects compared to the sys temic and local complications induced by alpha -adrenergic agonists. Copyri ght (C) 2001 S. Karger AG, Basel.