INTRACAVERNOSAL PHENYLEPHRINE FOR RECURRENT PRIAPISM: SELF-ADMINISTRATION BY DRUG DELIVERY IMPLANT

Abstract

A 28-year-old white man presented with a 3-year history of painful, nocturnal, prolonged erections. These erections occurred every night and lasted from 1 to 6 hours. Medical history included circumcision. The patient did not take any medication, and physical examination was normal. The etiology of the prolonged erections was unknown in that all hematological evaluations were normal and Doppler ultrasound excluded an arteriovenous malformation. Nocturnal penile tumescence monitoring confirmed a prolonged erection lasting for 4 hours. Treatment with 2.5 mg. procyclidine 3 times daily1 was unsuccessful as was 100 mg. cyproterone acetate taken at night. The surgical implantation of a penile drug delivery system to delivery phenylephrine was offered to the patient.2 Through a lateral penoscrotal incision the Brindley‡ drug delivery implant was placed with the cannula inserted into the lateral aspect of the right corpus cavernosum and sutured to the tunica albuginea with a nonabsorbable suture (see figure). The combined pump/reservoir was filled with saline and positioned in a dependent position in the scrotum. The patient was discharged home the next day. At 1-month followup the saline solution in the reservoir was withdrawn and phenylephrine solution was instilled percutaneously. After an initial titration period, 50 mg. phenylephrine solution (10 mg./ml.) diluted with normal saline to a volume of 8 ml. was percutaneously instilled into the reservoir. The patient was instructed on how to squeeze the pump so that 1 squeeze delivered 0.13 ml. (0.8 mg.) phenylephrine solution into the corpus cavernosum. The patient used the device for 4 months and was successful in reversing the prolonged painful erections.