Cavernosal aspiration for ischemic priapism: A stepwise procedural case report

Priapism is a urological emergency characterized by a prolonged erection not associated with sexual stimulation and requires urgent intervention to prevent irreversible complications such as erectile dysfunction. This case report discusses the management of ischemic priapism in a 44-year-old male taking trazodone, a medication known to precipitate priapism. Upon presentation, the patient exhibited severe penile pain and difficulty voiding. Physical examination confirmed ischemic priapism, prompting immediate cavernosal aspiration. This report focuses on a detailed stepwise approach to cavernosal aspiration. After sterile preparation and dorsal penile block anesthesia, a butterfly needle connected to a three-way stopcock was used to aspirate deoxygenated blood from the corpus cavernosum until flow ceased. This was followed by normal saline irrigation and further aspiration, then intracavernosal phenylephrine injection with repeated aspiration. Each step was repeated until detumescence was achieved, with aspiration halted at any stage if detumescence occurred. Compression dressings were applied at aspiration sites to prevent hematoma formation, and the patient was monitored post-procedure for recurrence. Understanding this procedure equips emergency physicians with the skills necessary to intervene promptly and effectively when specialist care is not immediately available.