Intracavernosal irrigation by cold saline as a simple method of treating iatrogenic prolonged erections
Review of: A. Ateyah, A.R. El-Nashar,W. Zohdy, M. Arafa, H. Saad El-Den. J Sex Med, 2, 248-253, 2005.
This straightforward clinical study reports a simple and effective treatment for prolonged erections caused by intracavernosal drug injections. 122 patients with drug-induced priapism were included. These patients had all been non-responders to orally administered PDE5-inhibitors and were using intracavernosal tri-mix regimens (papaverine, phentolamine and prostaglandin E1) or a single-drug regimen with only prostaglandin. Inclusion criteria were a prolonged erection lasting more than six hours and in all study cases therapeutic intervention was started exactly six hours after the onset.
Therapy consisted of a standardized protocol. First, external cooling was applied to the penis and perineal area, this solved the problem in 30 patients (24%). In the remaining patients, intracorporeal blood aspiration of 25 cc followed, which solved the problem for another 22 patients. The remaining 80 patients then underwent irrigation of the corpora with saline solution of different temperatures in randomly assigned groups (10∞, 15∞, 20∞ and 37∞C were used). The volume of saline used differed and depended on temperature. At body temperature of the irrigation saline this method was effective in 60% of patients, at 20∞C in 66%, at 15∞C in 90% and at 10∞C in 96% of the respective patient numbers. In 10 patients, irrigation was ineffective and they received intracorporal alpha-adrenergic injections.
This study provides convincing evidence that simple measures can be very effective and that intracorporal drug injections with their risk of hypertensive systemic responses may only be necessary in very few patients with druginduced priapism.