Subarachnoid hemorrhage as complication of phenylephrine injection for the treatment of ischemic priapism in a sickle cell disease patient.
BACKGROUND
Ischemic priapism (IP) is a urologic condition, which necessitates prompt management. Intracavernosal injection of phenylephrine is a usual treatment modality utilized for the management of these patients. Aim. We present a case of subarachnoid hemorrhage following intracavernosal injection of phenylephrine for IP in a patient with sickle cell disease.


METHODS
We analyzed the degree of subarachnoid hemorrhage in our patient after intracavernosal injection of phenylephrine. The patient had an acute rise in blood pressure during corporal irrigation. This was followed by the onset of severe headache. Computed tomography (CT) scan confirmed the diagnosis of a subarachnoid hemorrhage.


METHODS
Subarachnoid hemorrhage associated with intracavernosal injection of phenylephrine. Result. A 23-year-old African American male with a history of sickle cell disease presented with a painful penile erection. The patient was started on intravenous fluids, oxygen by nasal canula, and analgesic medication. After this, a blood gas was obtained from his left corpora cavernosa. This was followed by normal saline irrigation and injection of phenylephrine. The patient complained of a sudden, severe "terrible headache" immediately following the last injection, and noncontrast CT scan of the head was obtained and a subarachnoid hemorrhage was noted. The patient was admitted for observation and no significant changes were noted.


CONCLUSIONS
Intracavernosal injection of phenylephrine for the management of IP can be associated with several possible complications. We present our single case complicated with the formation of a subarachnoid hemorrhage. The patient was treated conservatively and had no long-term neurologic sequelae. Davila HH, Parker J, Webster JC, Lockhart JL, and Carrion RE. Subarachnoid hemorrhage as complication of phenylephrine injection for the treatment of ischemic priapism in a sickle cell disease patient.
Davila
Hugo H
HH
Division of Urology, Department of Interdisciplinary Oncology, Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Health Sciences Center, Tampa, FL, USA.
Parker
Justin
J
Division of Urology, Department of Interdisciplinary Oncology, Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Health Sciences Center, Tampa, FL, USA.
Webster
J Christopher
JC
Division of Urology, Department of Interdisciplinary Oncology, Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Health Sciences Center, Tampa, FL, USA.
Lockhart
Jorge L
JL
Division of Urology, Department of Interdisciplinary Oncology, Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Health Sciences Center, Tampa, FL, USA.
Carrion
Rafael E
RE
Division of Urology, Department of Interdisciplinary Oncology, Department of Surgery, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Health Sciences Center, Tampa, FL, USA. Electronic address: CarrioRE@moffitt.usf.edu.
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D006801:Humans; D007511:Ischemia / Q000150:complications; D008297:Male; D010413:Penis / Q000098:blood supply; D010656:Phenylephrine / Q000008:administration & dosage / Q000009:adverse effects*; D011317:Priapism / Q000188:drug therapy* / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000139:chemically induced* / Q000517:prevention & control; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D010656:Phenylephrine