title: Prophylactic phenylephrine for iatrogenic priapism: a pilot study with Peyronie's patients.
abstract: OBJECTIVE
  Although penile duplex Doppler ultrasonography (PDDU) is a common and integral procedure in a Peyronie's disease workup, the intracavernosal injection of vasoactive agents can carry a serious risk of priapism. Risk factors include young age, good baseline erectile function, and no coronary artery disease. In addition, patients with Peyronie's disease undergoing PDDU in an outpatient setting are at increased risk given the inability to predict optimal dosing. The present study was conducted to provide support for a standard protocol of early administration of phenylephrine in patients with a sustained erection after diagnostic intracavernosal injection of vasoactive agents to prevent the deleterious effects of iatrogenic priapism.
  
  
  METHODS
  This was a retrospective review of Peyronie's disease patients who received phenylephrine reversal after intracavernosal alprostadil (prostaglandin E1) administration to look at the priapism rate. Safety was determined on the basis of adverse events reported by subjects and efficacy was determined on the basis of the rate of priapism following intervention.
  
  
  RESULTS
  Patients with Peyronie's disease only had better hemodynamic values on PDDU than did patients with Peyronie's disease and erectile dysfunction. All of the patients receiving prophylactic phenylephrine had complete detumescence of erections without adverse events, including no priapism cases.
  
  
  CONCLUSIONS
  The reversal of erections with phenylephrine after intracavernosal injections of alprostadil to prevent iatrogenic priapism can be effective without increased adverse effects.
authors.affiliation: Department of Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA.
authors.forename: Pengbo
authors.initials: P
authors.lastname: Jiang
authors.affiliation: Department of Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA.
authors.forename: Athena
authors.initials: A
authors.lastname: Christakos
authors.affiliation: Department of Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA.
authors.forename: Mina
authors.initials: M
authors.lastname: Fam
authors.affiliation: Department of Urology, Rutgers-New Jersey Medical School, Newark, NJ, USA. ; Center for Male Reproductive Medicine & Microsurgery, Hackensack University Medical Center, Hackensack, NJ, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Sadeghi-Nejad
mesh_terms: D000527:Alprostadil / Q000009:adverse effects; D004341:Drug Evaluation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D010411:Penile Induration / Q000000981:diagnostic imaging*; D010656:Phenylephrine / Q000627:therapeutic use*; D010865:Pilot Projects; D011317:Priapism / Q000139:chemically induced / Q000517:prevention & control*; D012189:Retrospective Studies; D018616:Ultrasonography, Doppler, Duplex / Q000009:adverse effects / Q000379:methods; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D010656:Phenylephrine; D000527:Alprostadil
keywords: Alprostadil; Male urogenital diseases, Peyronie's disease; Phenylephrine; Priapism