Drug treatment, aspiration and perfusion, and surgical indications for priapism.

247.

Medications that can treat priapism

There is currently no magic cure for priapism that can be treated orally, intramuscularly, or intravenously, but some people abroad have tried it and two drugs are used to treat the condition.

(1) Methomyl-tert-butyl epinephrine, this drug is suitable for cases of penile priapism induced by intracavernosal injection of vasoactive drugs and cases of failed shunt surgery.

The dosage is 5 mg orally or 0.25–0.5 mg subcutaneously or intravenously. If ineffective, the dosage can be repeated after an interval of 4–6 hours.

(2) A synthetic sympathomimetic 2 agonist called Terbutaline has a weak B2 effect. It may relax all the smooth muscles of the corpus cavernosum, arteries, and veins, leading to dilation of the draining veins, while increasing the permeability of erectile tissue and promoting the inflow of intracellular and interstitial fluid into the venous system.

Side effects of this drug include tachycardia, pulmonary edema, and hypokalemia; these should be taken into account when using it.

248.

Correct application of corpus cavernosum aspiration and alpha-adrenergic receptor agonist infusion for the treatment of priapism

This method can cure most cases of priapism. With long-term follow-up, 50% of patients have recovered normal penile erection and sexual function.

This method is applicable to:

(1) Priapism induced by injection of various vasoactive drugs into the corpora cavernosa;

(2) Priapism of the penis with corpus cavernosum pressure or blood gas analysis showing carbon dioxide partial pressure close to normal;

(3) Non-ischemic idiopathic priapism with mild pain.

However, this is an invasive treatment method, and aseptic techniques must be followed during the procedure. The following steps must be strictly adhered to.

After local anesthesia with 2% lidocaine, insert an 18-gauge needle (or a corpus cavernosum pressure needle) into the dorsal side of the glans penis. While aspirating, gently squeeze the penis. Initially, the aspirated blood will be dark red. After aspiration, gently rinse with heparinized saline for 8-10 minutes. Do not use force to avoid damaging the fragile vascular network. Stop rinsing when the rinsed blood is bright red and the swelling of the penis has completely subsided.

Then, a diluted α-adrenergic receptor agonist is instilled through the same needle. Commonly used α-adrenergic receptor agonists include adrenaline, Aramine, norepinephrine, and dopamine. The concentration of adrenaline is 0.001 mg/mL. It is slowly instilled over 20 to 30 minutes, or it can be injected in multiple doses at 5 to 6-minute intervals, with aspiration during injection.

During the infusion process, the pressure inside the sponge was monitored, and the infusion was stopped when the pressure dropped below 5.32 kPa.

The side effects of the medication include occasional palpitations and elevated blood pressure.

The maximum dosage of these medications should be noted as follows: 0.5 mg of adrenaline, 0.015 mg of norepinephrine, 10 mg of Aramine, and 20 mg of dopamine.

249.

Surgical indications for priapism

Non-ischemic priapism and severe ischemic priapism that do not improve after 24 hours of treatment, due to irreversible fibrosis of the corpora cavernosa caused by long-term venous stasis, may result in loss of erectile function. Long-term venous stasis may also cause infection of the corpora cavernosa and urinary system. Therefore, early surgical treatment is advisable.

The key to a successful surgery lies in timing; the operation should be performed before a blood clot forms in the corpora cavernosa.

Therefore, surgery should be considered as early as possible if conservative treatment is ineffective in the initial stage.

250.

The purpose of surgical treatment for priapism

Surgical treatment of priapism serves several purposes:

(1) Remove blood stasis as soon as possible, restore blood circulation in the corpora cavernosa, and divert the blood in the obstructed corpora cavernosa to another venous system. This is the basis for the fact that all surgeries for this disease are diversion surgeries.

(2) It reduces the blood supply to the penile arteries, causing the penis to become flaccid;

(3) Based on the above two points, restore sexual function as much as possible.

Therefore, surgical treatment is more suitable for high-flow priapism.

251.

Types of surgical procedures for treating priapism

For various types of penile erectile dysfunction, if conservative treatment is ineffective, surgical treatment should be adopted promptly and decisively.

Currently, the commonly used surgical methods include the following: ① Corpus cavernosum-urethral spongiosum shunt; ② Great saphenous vein-corpus cavernosum shunt; ③ Dorsal vein-corpus cavernosum shunt; ④ Glans penis-corpus cavernosum shunt; ⑤ Femoral artery cannulation and pudendal artery embolization, etc.

Among the above surgical methods, the penile glans-cavernous body shunt is the most commonly used. It is simple, practical, easy to operate, has a definite curative effect, and is unlikely to cause erectile dysfunction.

252.

Traditional Chinese Medicine Diagnosis and Treatment of Priapism

(1) Damp-heat in the liver and gallbladder: Symptoms include persistent erection, burning, swelling and pain in the penis, accompanied by irritability, insomnia and dreaminess, damp scrotum, bitter and sticky mouth, and dark and scanty urine.

The tongue is red with a thin, yellow, greasy coating, and the pulse is wiry, slippery, and rapid.

Treatment principle: Soothe the liver and relieve depression, clear away damp heat.

Prescription: Modified Longdan Xiegan Decoction.

The medicinal ingredients include Rehmannia glutinosa, Gentiana scabra, Scutellaria baicalensis, Gardenia jasminoides, Alisma plantago-aquatica, Akebia trifoliata, Plantago asiatica, Angelica sinensis, Bupleurum chinense, and Glycyrrhiza uralensis.

(2) Yin deficiency with fire excess: Symptoms include persistent penile erection, swelling and pain, dizziness, blurred vision, lethargy, emaciation, soreness and weakness of the waist and knees, flushed face, tinnitus, dry mouth and throat, palpitations and night sweats, five-center heat, scanty dark urine, red tongue with little coating, and thready and rapid pulse.

Treatment principle: Nourish Yin and clear heat.

Prescription: Modified Zhi Bai Di Huang Tang.

Medicinal ingredients include Cornus officinalis, seaweed, kelp, stir-fried yam, tortoise shell, Rehmannia glutinosa, Anemarrhena asphodeloides, Phellodendron chinense, Paeonia suffruticosa, raw dragon bone, and raw oyster shell.

(3) Phlegm and blood stasis obstruction: After penile trauma, the erection is hard, the penis is swollen and painful and pulls on both sides, the penile skin is dark purple, or there are ecchymosis and petechiae, and it is swollen, hard and painful.

The tongue is purplish-dark, or has ecchymosis or petechiae, with little coating, and the pulse is deep and hesitant.

Treatment principle: Promote blood circulation, remove blood stasis, eliminate phlegm, and unblock the meridians.

Prescription: Modified Taohong Siwu Decoction combined with Erchen Decoction.

The medicinal ingredients include peach kernel, safflower, angelica, red peony root, chuanxiong rhizome, pinellia tuber, tangerine peel, poria cocos, sappanwood, achyranthes root, fritillaria bulb, and Sichuan pepper.

253.

Common Chinese patent medicines for treating priapism

(1) Gentianae Radix et Rhizoma Decoction: Suitable for damp-heat syndrome of liver and gallbladder.

Take one packet each time, twice a day.

(2) Zhi Bai Di Huang Wan: It is suitable for kidney yin deficiency with fire excess syndrome.

Take 1 pill each time, twice a day.

254.

Commonly used traditional Chinese medicine remedies for treating priapism

(1) Daoyang Decoction: 15g of Phellodendron bark and 10g of Anemarrhena rhizome, decocted in water and taken as a tea substitute.

(2) Modified Peony and Licorice Decoction: 60g each of red and white peony root, 15g of raw licorice root, 30g of *Lycopodium clavatum*, and 30g of raw coix seed.

Decoct in water and take one dose each morning and evening, or decoct in water and drink as tea.

(3) Licorice and Black Bean Soup: 60 grams of licorice and 200 grams of black beans, decocted into a soup to drink as tea.

(4) Decoction of Polygonum cuspidatum: 15g Polygonum cuspidatum, 10g Sappanwood, 6g Carthamus tinctorius, decocted in water and taken orally.

(5) Ze Xie Tang: 15-30 grams of Ze Xie, decocted into a tea and drunk as a substitute for tea, 1 dose per day.

(6) Take 3 grams each of Phellodendron bark, Anemarrhena rhizome, dragon bone, rhubarb, and immature bitter orange peel, decoct in water and take orally.

(7) Take 10 grams each of Anemarrhena asphodeloides, gypsum, Scrophularia ningpoensis, Rehmannia glutinosa, and soybean, decoct in water and take orally.

(8) Take 3 grams each of Phellodendron bark, licorice root, and Amomum villosum, decoct in water and take orally.

(9) Take 6 grams of Prunella vulgaris, decoct it into a tea and drink it as a substitute for tea.

255.

Western medicine treatments for anejaculation

Currently, there is no highly effective drug to cure anejaculation, but we can improve ejaculatory dysfunction by regulating autonomic nerve function based on the neurophysiological mechanisms of sexual physiology.

The following are some of the more commonly used medications:

(1) Ephedrine is an adrenergic receptor agonist that can enhance the contraction of smooth muscle in the ejaculation pathway, drive semen into the posterior urethra, and increase sexual arousal, thereby accelerating ejaculation. It is a commonly used drug to promote ejaculation.

The dosage is 25-50 mg each time, taken orally before bedtime, with an additional dose taken during sexual activity.

It can be taken continuously for 1 to 4 weeks.

If ineffective, medication should be discontinued and other treatment methods should be used.

(2) Levodopa: The dopamine system in the brain can promote ejaculation. Levodopa can increase the excitability of the ejaculation center and has a certain therapeutic effect on this condition.

It works better when used in combination with Dimetotiazine and Trihydroxyphenylacetone.

However, some believe that levodopa can impair ejaculation.

The dosage is 0.25g per dose, three times a day, orally, for half a month. If ineffective, discontinue use.

(3) Pilocarpine, a cholinergic receptor agonist, stimulates glandular secretion, promotes smooth muscle contraction in the ejaculation pathway, and promotes ejaculation.

It is a commonly used drug.

It is mainly suitable for men with normal penile erection firmness and duration.

The dosage is 4 mg, injected 15 minutes before sexual intercourse.

(4) Sex hormones: If a patient has decreased libido, weak erection or short duration of erection, human chorionic gonadotropin, methyltestosterone or testosterone propionate may be used for short-term treatment.

Other methods involve treatment with low-dose prednisone, which has certain benefits.

256.

Surgical indications for patients with ejaculatory dysfunction

The vast majority of patients with anejaculation can be cured through various conservative treatments.

However, if the inability to ejaculate is caused by local anatomical factors, it can be cured through surgery.

In cases of phimosis, the glans penis cannot be exposed, which can weaken the intensity of sexual stimulation; in cases of redundant foreskin, the foreskin may be retracted during intercourse, causing paraphimosis, pain, or frenulum pain and bleeding, or forcing the interruption of intercourse before ejaculation.

Therefore, circumcision should be performed on these patients. This can clean the glans penis, prevent balanitis, eliminate paraphimosis, sexual discomfort and pain, fully expose the glans penis, improve the sensitivity of sexual stimulation, enhance sexual arousal, and induce ejaculation.

Other patients with severe varicocele, which affects fertility, libido, and ejaculation, should undergo high ligation or other shunt procedures.

Urethral dilation can also be effective for some patients.