Editing Priapism (section)

===== Corporal aspiration, with or without irrigation =====
* '''<span style="color:#ff0000">Corporal aspiration''' 
**'''<span style="color:#ff0000">Refers to the intracavernosal placement of a needle followed by withdrawal of corporal blood.''' 
**Will immediately soften the erection and relieve pain
**May relieve priapism in 36% of cases
*'''<span style="color:#ff0000">Corporal irrigation'''
**'''<span style="color:#ff0000">Refers to subsequent instillation of fluid (typically saline) into the corpora after corporal aspiration.'''
*'''Corporal aspiration and irrigation are often combined''' to remove clotted, deoxygenated blood and restore arterial flow and smooth muscle and endothelial function. 
**They may be performed alone or combined with instillations of phenylephrine.
***No studies have compared aspiration and irrigation with saline to alpha adrenergic injections alone
***Studies suggest greater resolution rates with combination therapy of aspiration, irrigation, and intracavernosal alpha adrenergics compared to alpha adrenergics alone
*'''<span style="color:#ff0000">Technique[https://pubmed.ncbi.nlm.nih.gov/35536142/ ★]</span>'''
** '''Steps for aspiration/irrigation with phenylephrine administration:'''
**# Perform a penile block with local numbing medication (if not previously performed).
**# Place a 16-18 gauge butterfly needle in the 3 or 9 o’clock position (to avoid the dorsal neurovascular bundle) on the penis near the base.
**# Connect the butterfly needle to a 30-60 cc Luer Lock syringe.
**# Alternate between aspiration of blood clots and instillation of saline (chilled if available and if the patient does not have sickle cell disease) until some degree of detumescence can be achieved.
**# Instill phenylephrine.
**# Allow 3-5 minutes of time to pass.
**# Repeat steps 4-6 until detumescence is achieved or until the decision has been made to proceed with surgical shunting.
**# If temporary detumescence is achieved with aspiration followed by a rapid refilling of blood despite multiple attempts of phenylephrine instillation, consideration may be given to placement of a firm penile wrap at the time of aspiration to maintain detumescence.