What is the first step in the treatment of priapism?

The initial step in the treatment of priapism focuses on relieving the condition and restoring normal venous outflow from the penis. Penile shaft aspiration is an effective first-line intervention, especially in cases of compartment syndrome or ischemic priapism. By placing a needle into the corpora cavernosa at either the 2 o'clock or 10 o'clock position, healthcare providers can aspirate blood that has pooled and resolve the excess engorgement, which is crucial in preventing penile tissue damage.

This approach is preferred as it not only alleviates the painful and prolonged erection but also allows for the possibility of using a local anesthetic and subsequent treatment, such as the injection of phenylephrine if necessary, to facilitate further vasoconstriction if aspiration alone is not sufficient. The urgency of addressing priapism lies in the risk of erectile dysfunction or penile tissue necrosis, which underscores the importance of an immediate and correct application of this first procedure.

In contrast, while other interventions such as the injection of phenylephrine, administration of anticoagulants, or surgical interventions may come into play depending on the specific circumstances and duration of the priapism, they are not the immediate first step in management.