Intracavernous papaverine/phentolamine-induced priapism can be accurately predicted with color Doppler ultrasonography.
OBJECTIVE
To determine the value of penile duplex ultrasonography in predicting the occurrence of intracavernous drug-induced ischemic priapism directly after the rigid erection phase.


METHODS
We evaluated 250 men with erectile dysfunction by color Doppler ultrasonography after the diagnostic injection of papaverine hydrochloride and phentolamine mesylate. Cavernosal artery waveforms were recorded, and peak systolic velocity (PSV) and end diastolic velocity (EDV) of the recorded waveforms were measured. In cases of priapism, color Doppler ultrasonography findings were evaluated to identify any finding that would predict priapism.


RESULTS
In all, 41 patients experienced painful rigid erection for more than 1 hour after injection. All patients were divided into two groups. Group I included 16 patients who achieved full erection lasting less than 6 hours. Group II included 25 patients who achieved full erection lasting more than 6 hours. All patients of group I had PSV less than 61 cm/s and EDV of 0 to 2 cm/s. On the other hand, all patients of group II had PSV greater than 66 cm/s and EDV of 0 to 1 cm/s. These findings were accurate predictors of persistent erection requiring intervention in all 25 patients of group II and in none of the group I patients (100% specificity and sensitivity).


CONCLUSIONS
Our results show that during the first hour of penile color Doppler ultrasound study, PSV of 66 cm/s or more together with EDV of 0 cm/s is a reliable predictive factor for priapism. This finding is reliable enough that treatment for priapism should be initiated without further delay.
Metawea
Bahgat
B
Andrology and Sexually Transmitted Diseases Department, Cairo University Hospital, Cairo, Egypt.
El-Nashar
Abdel-Rahman
AR
Gad-Allah
Amr
A
Abdul-Wahab
Mazen
M
Shamloul
Rany
R
D000328:Adult; D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D010208:Papaverine / Q000008:administration & dosage*; D010413:Penis; D010646:Phentolamine / Q000008:administration & dosage*; D011237:Predictive Value of Tests; D011317:Priapism / Q000139:chemically induced* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D018615:Ultrasonography, Doppler, Color
D010208:Papaverine; D010646:Phentolamine