COTW November 20th: A 70 y/o male with a painful erection...

A 70 y/o male presents complaining of a persistent and painful erection for more than 4 hours. He reports taking an injection for erectile dysfunction prior to the onset of symptoms.

You decide to perform a corporeal aspiration using a penile nerve block….

Quickly reviewing the anatomy, note that as long as your local anesthetic spreads deep to Buck’s fascia, the anesthetic may reach both dorsal penile nerves with a single injection as there is no physical barrier between them:

Here’s what it looks like:

After a few minutes, you can safely aspirate from the corpora cavernosa:

Aspirate 25mL of blood, up to two times

You can also inject 100-500 mcg of phenylephrine every 3-5 mins (max dose: 1000 mcg), but make sure the patient is fully monitored!