Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a persistent, painful penile erection lasting [X] hours. Denies recent trauma to the perineum or genitalia. Reports [no/yes] history of sickle cell disease, hematologic malignancy, or use of intracavernosal injection therapy/PDE5 inhibitors. Pain is described as [mild/moderate/severe] and progressive.
Clinical Examination Findings
Physical exam reveals a rigid, tender corpora cavernosa with a soft, flaccid glans penis. Penile shaft is extremely tender to palpation. No evidence of perineal hematoma or trauma. Vital signs are stable. Cavernosal blood gas analysis (if performed) demonstrates: pH [value], pO2 [value], pCO2 [value], consistent with severe hypoxia, hypercapnia, and acidosis.
Treatment Protocol
Immediate management initiated: 1. Penile block with local anesthesia. 2. Aspiration of stagnant, dark blood from the corpora cavernosa. 3. Intracavernosal irrigation with normal saline. 4. Intracavernosal injection of sympathomimetic agent (e.g., Phenylephrine) titrated to effect. If refractory, consider distal shunting procedure (e.g., Winter, Ebbehoj, or Al-Ghorab shunt).