I spent about an hour last night squeezing a man's penis. And no, it wasn't my husband's!!!!
As you can guess, I was on call last night and was about to retire to bed when I was called in for a priapism (painful sustained erection of more than 4 hours). This poor man did not have any risk factors for developing priapism, and was actually a nice, albeit unfortunate man. I had to do some intra-corporeal irrigation (which involves putting a needle in the penis and flushing the blood out with some saline), and manual compression (hence the squeezing), and finally his erection went down. I was able to get a few precious hours of sleep until 5AM when I assisted on a kidney transplant.
However, as I was doing all this in the ER, I kept thinking about the utter absurdity of the situation. I wonder how many male urologists would also think this was a somewhat "strange" situation...
I also did something a "ridiculous" in clinic yesterday, when I accompanied my patient into the toilet to watch her urinate with a pen light. She was complaining of a "strange stream", and I felt the only way to assess the situation thoroughly was to observe the act. Ahhh, the things we have to do... enough to put a smile on my tired face.
Wednesday, January 10, 2007
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18 comments:
Same thing happened to me just the other day, only I was on the other end of the stick, so to speak... and fortunately it didn't reach the point that I had to go to the ER.
Two weeks ago my friendly neighborhood urologist gave me a 2.5 mcg. Caverject injection into my penis (my first) following a 11/17/06 radical prostatectomy. When I returned a week later, I told him that 2.5 mcg. hadn't done much for me (I rated it a 3 x 10 on the firmness scale). So he told me to crank the second one up to 10 mcg., which I did under his supervision and then returned to work.
Three hours later, on the same 10-point scale, firmness was at about a 12, and painful! Hoping to avoid a Sudafed injection or the type of irrigation that you describe, I stuck it into a jar of ice-water. This seemed to work, as the erection subsided.
Today I met with the director of sexual medicine at Sloan-Kettering Cancer Center who told me that I never should have been allowed to leave the urologist's office, and I shouldn't have allowed it to go for three hours, but no harm seemed to have been done. (He also said that he didn't believe that the ice-water did the trick for me; he said the timing was more likely coincidental.)
From medical discussions that I've had, from the point of view of a prostate cancer survivor, I get the impression that priapism is not terribly unusual and needn't be serious, if treated promptly.
Hi, I found this post very amusing and informative. I had no idea that was how you treat priapism! Hehe, I can't wait to tell my husband this information and see his face go "ouch". Sorry, no offense to priapism patients. BTW, I really enjoyed your posts, I like your style of writing. I'm going to blogroll you, if that's ok.
Dr keagirl - How do you function on so little sleep? Is it the training from your surgical residency? And your not working in Macy's spraying perfume on people - you are removing kidneys, etc.
It is 2:42 am east coast time and I am still up because I have been trying to find info on the boari flap/psoas hitch open surgery.
If I had a penis, erectile dysfunction, prostate problems,prolapsed uterus, bladder problems, kidney problems or any problem that can be corrected with laparoscopic procedures, or need info on a nephrectomy, or want info on intrinsic obstruction, extrinsic obstruction, UPJ, etc., etc., etc. - I can find info about these topics.
Can I find ANY info on an open boari flap/psoas hitch surgery? Hardly!
And when I do find info on it,it is regarding a laparoscopic procedure to correct it. WHY is it so hard to find this info? I am really interested in the open surgery and perioperative time and prognosis. I have been looking up info on Cornell and Johns Hopkins urologists and their specialties, but they never mention that surgery. They specialize in everything else. Is it that the boari flap/psoas hitch is so common that it is a given that any urologist does it? But then why isn't there much info available?
Sorry - just venting!
Wait - now you have to tell the end of the "strange stream" story. What the hell was that all about? I'm medically curious, of course.
As a PACU nurse, I've seen a few cases of priapism cases come through the OR. The strangest case involved a prisoner that had purposefully taken another inmates medicines.. wonder what was going on there? hmmmmmmmmmmmmm......
I'm just thinkin' out loud here, but you know you wouldn't get to have this much fun if you'd actually gone to vet school. Plus you'd be sneezing a lot.
Early one morning I was scheduled for a cystoscopy. I said to the Urologist: "What a way to start the day!". He replied: "How do you think I feel?".
That cysto comment is really funny Anonymous - :)
Once, I told my old dentist that I would rather get a pap test (true) then go to the dentist. He told me to lie back and he would try to accommodate me. Then when I went to my new dentist - I told him to be gentle or I would bite him. He then said "That's ok I'll bite you back."
I am such a baby at the urologist office when he does that procedure to get the pure urine. It feels worse when a stent is in. My breathing is just shy of a scream, a kick or hyperventilating or all of the above. Seriously!
Having said that - I would STILL rather do that then go to the dentist.
Sorry for going off topic - :)
Very funny (probably not for the patient though). Was there maybe some viagra or cialis involved? If my husbands erections lasted 4 hours, I would have to move out :)
I don't think the layman appreciates all the weird stuff doctors have to deal with.
As a female urologist across the other side of the world, it is good to know that I am not the only female having to squeeze blood out of a penis in the middle of the night!
I have rarely ever consulted a urologist for priapism in the ER. Here's what I usually do and it has usually worked well. Please feel free to comment.
1. Terbutaline
2. NaHCO3, 1 amp into a NS bag and bolus.
If above fail, corporal injection at the base with diluted phenylephrine.
Just to say I really like your blog - keep up the good work! It seems that medical stories can be similar the world over. I have decided to add you as a link to my blog... hope that's OK.
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Keagirl....I have a couple of female uros in my area (drug rep)and I am trying to guess if you are one of my friends or if I have met you. Like my local female docs, you have a great sense of humor. One of my docs is a yoga-holic, but I don't think you are she. I enjoy having you women in my area and those of you I have met a AUA's and meetings are a blast. Keep up the good work...girl power.
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