Patient handout

Priapism — urological emergency (ischemic / non-ischemic / stuttering / SCD-driven / drug-induced)

PRODUCTION

1. Your condition

This handout is for priapism — urological emergency (ischemic / non-ischemic / stuttering / scd-driven / drug-induced). Your care team identified this based on: painful prolonged erection >4 h — ischemic priapism (aua 2022).

Other reasons your team may use this plan: painless partial tumescence — non-ischemic / high-flow priapism (aua 2022); known scd with vaso-occlusive crisis + priapism (ash scd 2014); recent intracavernous pge1, trazodone, antipsychotic, cocaine, methamphetamine exposure (aua 2022).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
phenylephrine	100–500 µg in 1 mL sterile saline intracavernous q3–5 min	intracavernous	q3–5 min PRN	AUA 2022 first-line intracavernous sympathomimetic; selective α1 agonist with minimal β effect — preferred over epinephrine; ~80% success if <12 h (intracavernous epinephrine series)
acetaminophen	15 mg/kg PO/IV (max 1 g/dose adult)	PO/IV	q6h, max 4 g/day adult	Multimodal opioid-sparing (AUA 2022)
morphine	0.1 mg/kg IV (typical 4–10 mg adult)	IV	q3–4h PRN	Severe ischemic pain (AUA 2022)

Plan: Ischemic priapism — aspiration + intracavernous phenylephrine → shunt → prosthesis (AUA 2022)

3. When to call your provider

Contact your care team if any of the following happen:

Breakthrough episode >4 h → STAT ED (AUA 2022)
New persistent ED → uro + sexual medicine (AUA 2022)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Ischemic priapism 4–12 h — pharmacotherapy typically successful (AUA 2022)
Ischemic priapism 12–24 h — pharmacotherapy success drops; consider early shunt (AUA 2022)
Ischemic priapism 24–36 h — fibrosis risk rising; shunt + counsel ED + future fibrosis (AUA 2022; Burnett NEJM)
Ischemic priapism >36 h — severe ED + fibrosis likely; early penile prosthesis (AUA 2022; Burnett NEJM)(life-threatening)
SCD priapism — parallel exchange transfusion + uro pathway (ASH SCD 2014)
Drug-induced priapism (trazodone, antipsychotics, intracavernous PGE1, cocaine, methamphetamine) — discontinue offending agent + ischemic algorithm (AUA 2022)
Penile implant complication (mechanical failure / infection) — STAT uro + antibiotics + explant evaluation (AUA 2022)

5. Follow-up

Urology 1–2 wk; sexual function counsel + IIEF-5 at 3 / 6 / 12 mo; SCD comorbidity management + hydroxyurea optimization; psychological support if orchiectomy-equivalent ED outcome (AUA 2022; Arap-pattern outcomes)

6. Sources

Guideline: AUA/SMSNA Acute Ischemic Priapism Guideline 2021 (Bivalacqua, J Urol 2021 PMID 34495686) + AUA/SMSNA Recurrent Ischemic / Sickle-Cell / Non-Ischemic Priapism Guideline 2022 (Bivalacqua, J Urol 2022 PMID 35536142) + Broderick ICSM priapism review (J Sex Med 2010 PMID 20092449). Sickle-cell systemic management routes to heme.sickle-cell.core.v1.