A 29-year-old patient who came to the Emergency Department of our Hospital in the presence of a slightly painful erection of ten hours of evolution.
The patient reported having had four similar episodes in the last three months but in all of them the erection had dropped within three or four hours.
The patient denies the history of penile trauma, the use of other drugs including intraosseous injections or other drugs.
There were no other accompanying symptoms such as asthenia, anorexia or fever.
Blood gas analysis was performed on extracted from venous blood bodies mEq, obtaining analytical results (pCO2 163.1 mmHg, HCO3 13.2/l plasma).
Having this long-term priapism and the absence of pain make us think of a high-flow priapism, we proceed to try to reverse the erection as soon as possible, with the aim of calming down
He was punctured with a 19G intravenous catheter on both bodies repeatedly aspirating blood and letting it drop.
After this first step, there is no reduction in erection, so a solution of phenylephrine (alpha-adrenergic agonist) is prepared in saline solution at a concentration of 0.1 mg/ml.
2 ml of the solution is injected into a pinched body, compressing it later.
This maneuver is repeated again in the contralateral body.
If there is no response, a new solution of phenylephrine is administered, mixing 10 mg of phenylephrine into 11 of saline solution and 20-30 ml of this solution is introduced into each.
After repeating this last maneuver on several occasions, penile flaccidity is finally achieved.
During their stay in the emergency room and after getting flaccidity, blood tests are taken that reveal a marked increase in the numbers of leukocytes (414 x 109/L) and platelets (1100 x 109/L) in the blood.
The suspicion of a myelooproliferative syndrome is consulted with the Hematology Service, which diagnose chronic myeloid leukemia.
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Subsequently, the patient underwent allogeneic bone marrow transplantation from a family donor with identical HLA.
The evolution of the disease is favorable, leaving the picture of priapism totally resolved when treating chronic myeloid leukemia without alteration in sexual potency.
