Urology: priapism: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Urology: priapism

Sample item

A 22-year-old man with sickle cell disease has had a painful rigid erection for 8 hours. The glans is soft. Cavernosal blood gas shows a dark blood with pH 7.0 and low oxygen. What is the next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Aspiration of the corpora with intracavernosal phenylephrine

Ischaemic (low-flow) priapism is a compartment syndrome of the penis and an emergency, since irreversible erectile dysfunction follows after about 24 hours. Treatment is stepwise: analgesia, corporal aspiration with saline irrigation and intracavernosal alpha-agonist (phenylephrine), then shunting if this fails. Sickle cell disease is a common cause, and hydration, oxygen and exchange transfusion may be added.

Option by option

  • A. Immediate distal shunt without aspiration

    Surgery is escalated to only if aspiration and injection fail.

  • B. Aspiration of the corpora with intracavernosal phenylephrine (correct)

    Decompressing the corpora and causing vasoconstriction restores venous outflow.

  • C. Oral sildenafil

    Phosphodiesterase inhibitors promote erection and could worsen the condition.

  • D. Application of cold packs and analgesia alone

    Conservative measures alone rarely resolve established ischaemic priapism after several hours.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Aspiration of the corpora with intracavernosal phenylephrine. Ischaemic (low-flow) priapism is a compartment syndrome of the penis and an emergency, since irreversible erectile dysfunction follows after about 24 hours.

Why is "Immediate distal shunt without aspiration" not the answer?

Surgery is escalated to only if aspiration and injection fail.

Why is "Oral sildenafil" not the answer?

Phosphodiesterase inhibitors promote erection and could worsen the condition.

Why is "Application of cold packs and analgesia alone" not the answer?

Conservative measures alone rarely resolve established ischaemic priapism after several hours.

What concept does this question test?

It tests Urology: priapism in General Surgery. Treatment is stepwise: analgesia, corporal aspiration with saline irrigation and intracavernosal alpha-agonist (phenylephrine), then shunting if this fails. Sickle cell disease is a common cause, and hydration, oxygen and exchange transfusion may be added.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Urology: priapism?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.