Management of 62 cases of priaplsm following intracavernosal injection of papaverine

ABSTRACT

Priapism induced by intracavernous injection of vasoactive drugs is uncommon and easily managed. It could be treated by puncture of the corpora and injection of alpha-adrenergic drugs or by surgical intervention. The aim of this study is to find an easy uncomplicated and less invasive method for treatment of patients developed post injection priapism. Out of 1180 impotent patients injected with papaverine intracavernosally as an office test. 62 cases [5.3%] developed priapism. Eighteen cases of them had primary psychogenic impotence while 44 cases had secondary impotence and a possible organic cause for their impotence. Conservative treatment was attempted in all cases during the first 24 hours. Priapism resolved spontaneously with conservative treatment in 38.9% [7 out of 18] of patients having psychogenic impotence and in 15.9% [7 out of 44] of patients having secondary impotence and possible organic cause for their impotence. So conservative treatment alone was effective in about 22.5% [14 out of 62] of all patients. After 24 hours aspiration of the corpora was done using two butterfly gauge No. 15 needles each one was fixed into one corpous cavernosum at the mid penile shaft. The amount of aspirated blood differed according to the patient response, untilcomplete detumesence achieved, and it ranged between 150 and 350cc. This method resulted in aspiration of a relatively large amount of blood from the corpora washing the drug [papaverine] out of the corporeal tissue and avoids the injection of vascontrictors into the corpora with its possible sequelae on cardiac or hypertensive patients. Subcutaneous hematoma developed in 5 cases and they were treated conservatively. After 2 weeks all psychogenic cases regained their normal potency while patients having secondary impotence their potency returned to the preinjection baseline