Overview of Penile Injection and Aspiration

Penile injection and aspiration is a medical procedure that treats a condition called priapism. Priapism is when you have an erection that lasts longer than 4 hours, without any sexual stimulation. There are three varieties of this condition: ischemic, non-ischemic, and stuttering.

Ischemic priapism happens when not enough blood is flowing into the penis. Non-ischemic priapism is when there’s too much blood flowing into the penis. Stuttering priapism is when someone experiences recurring episodes of the ischemic type.

It’s important to remember that ischemic priapism is an emergency because it can harm the penis. But, non-ischemic priapism is not considered an emergency because it doesn’t stop the penis from getting artery blood.

Complications that cause ischemic priapism are medications, drug use (nonprescription), abnormal blood composition, cancer, fat embolism (which is fat particles in your blood), intravenous contrast use (a special dye used in some medical tests), neurological causes, hormonal issues, metabolic diseases, and toxins.

It’s critical that ischemic priapism is diagnosed and treated quickly because it’s an emergency and could cause harm to the penis if not addressed.

On the other hand, non-ischemic priapism is usually caused by trauma that leads to uncontrolled blood flow into the penis. Although it can be uncomfortable, it generally isn’t an immediate threat because blood flow to the penis isn’t restricted, so immediate treatment isn’t usually required.

Anatomy and Physiology of Penile Injection and Aspiration

The penis has a unique structure that consists of several key areas important for procedures like injection and aspiration. Starting from the outer layer, we have the skin and a layer beneath it called the dartos fascia. Deeper yet, we have a vein called the superficial dorsal vein, surrounded by a structure known as Bucks fascia. Inside this fascia, there are three cylindrical structures and a bundle of nerves and blood vessels.

The three cylinders within the penis perform distinct functions. Two of these are called the corpora cavernosa, which fill with blood during an erection, making the penis stiff. The third cylinder, the corpora spongiosum, surrounds the urethra (the tube that carries urine and semen out of the body) and prevents it from collapsing during an erection. These cylinders are covered with a tough layer called the tunica albuginea and there are small openings, or fenestrations, that allow blood to move between the cylinders.

An erection is achieved through sexual stimulation, which triggers the body’s ‘rest and digest’ response and releases a chemical called nitric oxide. This process dilates the arteries in the penis, allowing increased blood flow and swelling of the penis. Once the penis is fully erect, this pressure can reach approximately 100mmHg. When the stimulation ends, the process is reversed, and the penis returns to its normal state.

A condition known as ischemic priapism occurs when there is a lack of oxygen-rich blood flowing into the penis and lack of oxygen-depleted blood flowing out. It’s thought that this is due to an imbalance in the chemical processes in the penis that can cause the blood to become thick and coagulate, or clot, within the cylinders. This clotting can damage the tissue and prevent further blood flow out of the penis, leading to scar tissue formation.

Non-ischemic priapism, on the other hand, is often the result of physical trauma that damages the arteries, causing high blood flow into the penis but without the restriction on blood flow out of the penis. Treatments for this condition can include observation, embolization (blocking a blood vessel), or surgical ligation (tying off a blood vessel).

Why do People Need Penile Injection and Aspiration

If a man has a painful erection that persists for less than 72 hours, called ischemic priapism, a treatment option is to use a technique called penile injection and aspiration. This is where medication is injected into the penis and blood is removed using a thin needle. This can help to relieve the persistent erection, especially if other less invasive techniques haven’t been effective.

If the painful erection lasts longer than 72 hours, future natural erections may become unlikely. In such cases, the primary treatment becomes pain management, as more aggressive treatments may not be beneficial.

When a Person Should Avoid Penile Injection and Aspiration

When a person has ischemic priapism, a painful, long-lasting erection that is not caused by sexual stimulation, waiting more than 72 hours to get medical treatment might mean that they can’t get an erection naturally afterwards. That’s because doctors usually treat this problem by injecting medication into the penis and drawing out excess blood, which can help the person to get erections naturally again. Any time a person has ischemic priapism, it’s a medical emergency, so there’s no other situation where someone wouldn’t be able to get this treatment.

Equipment used for Penile Injection and Aspiration

Surgeons require numerous supplies while performing a medical procedure. These supplies differ according to the requirements of the surgery. Here are the materials required for certain medical procedures:

* Antimicrobial prep: This is a solution used to clean the skin before surgery to help prevent infections.
* Fenestrated drape: A medical sheet with a hole that allows the surgeon to protect the surrounding areas of the patient’s body while still accessing the surgical site.
* Sterile gloves: These are gloves that surgeons wear to create a protective barrier against germs.
* Anesthetic: In this instance, surgeons use lidocaine, which is a type of local anesthetic that numbs a specific area of the body. It’s delivered using a syringe and needle.
* Large bore butterfly needle: This is a special needle used for drawing blood or injecting fluid into the veins.
* Blood gas syringe: This is used to draw a small amount of blood in order to measure the amount of certain gases present in the blood.
* Saline flushes: Normal saline is a solution that is used to cleanse or rinse certain areas during a surgical procedure.
* Empty 20 mL to 30 mL syringe: This is a tool used to either withdraw bodily fluids, or to inject substances into the body.
* Phenylephrine solution: It’s a medication commonly used to constrict the blood vessels, which can help control bleeding. It comes in a concentration of 100 micrograms to 500 micrograms per mL.
* Dressings: These are materials used to cover and protect a wound after the operation. They include gauze, which is a type of thin, translucent fabric and a self-adherent wrap which sticks to itself but not to skin or hair.

Who is needed to perform Penile Injection and Aspiration?

A simple procedure called penile injection and aspiration is usually done in the emergency room. This is done by a doctor who specializes in emergency cases or a urologist, a doctor who deals with urinary tract and sexual organ issues. This procedure doesn’t usually need any other helpers but if necessary, they can be called in to assist.

Preparing for Penile Injection and Aspiration

Before starting any procedure to treat priapism, which is a long-lasting, often painful erection that can occur without sexual activity, it’s crucial for the doctor to understand the patient’s medical history and current condition. In particular, the doctor needs to know how long the erection has been lasting and whether the patient is feeling pain. Checking for any previous instances of priapism, recent injuries, or usage of certain medications and recreational drugs is also important. The doctor also needs to be aware of any existing blood disorders, including leukemia or cancer.

The doctor will then perform an examination focusing on the genital area as well as check the patient’s blood pressure. High blood pressure can be a serious concern as treatment can potentially elevate it further. During the examination, the doctor will assess the stiffness and sensitivity of the erection. If the penis is extremely rigid and sensitive, this might point towards ischemic priapism, a painful condition caused by blood trapped in the penis. On the other hand, if the erection is only partially rigid and less sensitive, this could indicate non-ischemic (high flow) priapism, a less common form of the condition which is often painless as blood flow to the penis is not completely blocked.

In addition to the physical exam, a few lab tests would need to be performed. The doctor will run a complete blood count (CBC), which measures the number of different cells in your blood, and take a blood sample directly from the penis itself. If the blood is dark and thick, it usually points to ischemic priapism, while brighter red blood might suggest non-ischemic priapism. The condition can be accurately diagnosed by testing the acidity (pH), oxygen (pO2), and carbon dioxide (pCO2) levels of the blood collected from the penis.

Imaging tests like MRI scans are not usually required immediately. However, if the doctor suspects the presence of cancer, an MRI would be recommended as it provides a detailed image of the area. If high flow priapism is suspected, a penile Doppler test can be done, which uses ultrasound to measure blood flow in the arteries of the penis.

How is Penile Injection and Aspiration performed

Preparation

The entire penis, including its base, should be cleaned thoroughly with soap or antiseptic. This step is important to prevent any infection when the doctor performs the procedure. After cleaning, sterile covers are placed on and around the penis to keep the area clean during the procedure.

Procedure

There are 2 options available for dealing with any discomfort during the procedure: medication to numb the area, or using no medication at all. Medication can be injected into the top or around the penis to numb it. It can also be injected into the skin where the doctor plans to insert the needle. Once it takes effect, there should be no pain or discomfort felt during the procedure.

The main part of the procedure involves putting a large needle into a part of the penis. This is usually done at either the 2 to 3 o’clock or the 9 to 10 o’clock position (as if looking down at the penis as if it were a clock’s face), near the base of the penis. This needs to be done carefully, as they do not want to accidentally injure parts like the urethra (tube where urine and semen come out), the nerves or blood vessels on top of the penis, or puncture through to the other side.

Only one side of the penis needs to be injected and drained, because the two main chambers of the penis (“corpora cavernosa”) are linked together. Keeping the number of needle punctures low helps to lower the chances of getting a bruise on the penis. Once the needle is in the correct position, the doctor will try to draw out fluid using a large syringe. Sometimes, this may be difficult as the blood inside the penis may have thickened. In these cases, they may need to flush the area with a saline (salt) solution, and then try drawing out the fluid again. This can be repeated several times as needed. If there is no progress, a drug known as phenylephrine may be injected in small doses. The patient’s blood pressure and other signs should be monitored carefully throughout this process, as phenylephrine can increase blood pressure. Normally, the maximum dose of phenylephrine used is 1000 micrograms.

The procedure is considered successful once the penis becomes flaccid (not erect) again. At this stage, patients should be observed for any signs that the erection is coming back, and any symptoms relating to the phenylephrine injection.

Post-procedure

After the procedure, a gauze and adhesive wrap can be placed on the site where the needle was inserted. This helps to prevent bruising of the penis. Finally, patients are advised to return to the clinic or hospital if the erection comes back.

Possible Complications of Penile Injection and Aspiration

During the procedure, it’s common to feel pain even after numbing the area. A drug called Phenylephrine is often used, but it does come with risks. Some possible side effects of this drug include headaches, dizziness, blurry vision, high blood pressure, slow or fast heart rate, and irregular heartbeats. Because of these potential risks, it’s important that your doctor watches your vital signs closely. They will also limit the amount of Phenylephrine used to 1000 micrograms within an hour. That being said, sometimes the procedure might need to be done again, or a more invasive procedure might be needed if the problem comes back.

After the procedure, you might notice a painful swelling (‘hematoma’) caused by blood collecting in the area after the internal organs are punctured. But, this can be reduced with proper bandaging that applies pressure to the area. Also, the longer the priapism (a prolonged and often painful erection) lasts, the higher the chance of experiencing future problems with maintaining an erection, due to fibrosis (the formation of extra fibrous connective tissue).

In some cases, this fibrosis may also cause the penis to become shorter.

What Else Should I Know About Penile Injection and Aspiration?

If someone has a condition called ischemic priapism, which is a painful and long-lasting erection not caused by sexual activity, it can cause serious damage to the erectile tissue in the penis. To avoid such a problem, a procedure involving injections and drawing out fluid (aspiration) from the penis is very beneficial.

Doctors can carry out these techniques, especially those who are at ease doing minor procedures at a patient’s bedside. It’s important because these procedures play a crucial part in maintaining the health of the erectile tissue, which is necessary for normal sexual function.

Frequently asked questions

1. What are the potential risks and side effects of the penile injection and aspiration procedure? 2. How long does the procedure typically take, and will I need any anesthesia or numbing medication? 3. What can I expect in terms of pain or discomfort during and after the procedure? 4. Are there any specific instructions or precautions I should follow after the procedure to promote healing and prevent complications? 5. How likely is it that I will need additional treatments or procedures in the future to address my priapism?

Penile injection and aspiration can have an impact on the structure and function of the penis. The procedure involves injecting medication into the penis to treat conditions like priapism. The penis has specific areas, such as the corpora cavernosa and corpora spongiosum, which play a role in achieving and maintaining an erection. The injection and aspiration process can help restore normal blood flow and alleviate symptoms.

You would need Penile Injection and Aspiration if you have ischemic priapism, a painful and prolonged erection that is not caused by sexual stimulation. This treatment is necessary to relieve the condition and prevent long-term complications, as waiting more than 72 hours without treatment can result in permanent erectile dysfunction.

You should not get Penile Injection and Aspiration if you have ischemic priapism and wait more than 72 hours to seek medical treatment, as this delay may result in the inability to have natural erections afterwards. It is important to seek immediate medical attention for ischemic priapism as it is a medical emergency and requires prompt treatment.

The recovery time for Penile Injection and Aspiration is not specified in the given text.

To prepare for Penile Injection and Aspiration, the patient should thoroughly clean the entire penis, including the base, with soap or antiseptic to prevent infection. After cleaning, sterile covers are placed on and around the penis to keep the area clean during the procedure. The patient can choose to have medication injected into the penis or the surrounding area to numb it and prevent any pain or discomfort during the procedure.

The complications of Penile Injection and Aspiration include pain during the procedure, potential side effects of the drug Phenylephrine such as headaches, dizziness, blurry vision, high blood pressure, slow or fast heart rate, and irregular heartbeats. There is also a risk of hematoma (painful swelling caused by blood collecting in the area), priapism (prolonged and painful erection), fibrosis (formation of extra fibrous connective tissue), and potential shortening of the penis.

Symptoms that require Penile Injection and Aspiration include a painful erection that persists for less than 72 hours, known as ischemic priapism, and a persistent erection that lasts longer than 72 hours, which may lead to future natural erections becoming unlikely.

There is no information provided in the given text about the safety of penile injection and aspiration in pregnancy. It is recommended to consult with a healthcare professional for specific advice regarding this procedure during pregnancy.

Join our newsletter

Stay up to date with the latest news and promotions!

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

We care about your data in our privacy policy.