Protocols - Hemorio

RECURRENCE OF PRIAPISM:
- Pain Treatment
- Reduce the chance of impotency – keep an erection
Objectives
- Reduce the chance of relapse – fibrosis
- Reduce psychological disturbs
- Non-expensive, simple and compliant treatment.
- Information to target-population
Register - To ask priapism diary (write down frequency, duration).
- Urinate always before bedtime,
General actions - Ingest less liquid at night,
- Avoid alcohol and opioids
Home
Treatment
Urologist
Conduction
- In case of priapism for more than 45 minutes, administrate 2 tablets Efortil DU.
- In case of priapism persistence, administer 1 tablet of Diestilbestrol 1mg (DES)
- In case of refractory for more than 3 hours, contact immediately an urologist
- Start finasteride 5 mg 1x/day for 30 days and observe answer
- Obtaining good response, reduce for 2,5mg/day during 30 days and then try maintenance with the
lowest dose possible (1mg day or alternating days).
- Refractory cases to finasteride (5mg/day), associate DES 1 mg DU daily.
- Achieving priapism control, start drug reduction (initiating with DES, 1/2mg day). Try keeping with
the lowest dose of DES possible.
- Patients that experience severe side effects to DES (gynecomastism, delayed development) or
not responsive to DES.
- Self-injection, intra-cavernous with etilephrine solution.
NOTE: Consider HU use, in case of severe or recurrent priapism
SEQUELS OF PRIAPISM (Erectile Dysfunction)
- Study cavernous bodies with penile Doppler and IC drug
- Intracavernous test
- Encourage sildenafil, tadalafil, PO, use.
- Encourage vacuum therapy (including preparation to prosthesis placement)
HEMOSPERMIA:
- Request urinary system and prostate (pelvis) ultrasound to rule out surgical diseases. Evaluate BK
- Men with coagulation disturb – finasteride 5 mg for 2 months associated to Ipsilon criteria
- If smoker: urinary cytology – neoplasm cells research
MICROSCOPIC HEMATURIA:
- Request urinary system and prostate (pelvis) ultrasound
- Request dimorphism of erythrocyte (research of crenate red blood cells) – Hematuria study from
glomerular origin x excretory tract, evaluate BK.
- If the exams are negative or show proteinuria presence, request nephrology opinion.
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