In this episode of Pearls & Perspectives, host Amy Pearlman, MD, is joined by Gregory Broderick, MD, of Mayo Clinic Florida, and Serge Carrier, MD, of McGill University, for a timely discussion recorded ahead of their plenary session at the 2025 American Urological Association (AUA) Annual Meeting in Las Vegas, NV. Together, they break down the clinical and procedural nuances of priapism—from test injections in the office to surgical intervention in the ER. Broderick and Carrier, both long-time contributors to AUA guideline development, walk through a staged, case-based approach to managing prolonged erections. Pearlman opens with the common scenario of an in-office diagnostic injection leading to prolonged tumescence—an awkward, and potentially dangerous, outcome if not handled properly. They discuss the importance of efficient protocols, availability of phenylephrine, and why sending a patient “to another room to take care of it” is neither practical nor safe. Carrier emphasizes the urgency of intervention once priapism crosses the ischemic threshold. He outlines what to do when patients show up with erections lasting more than 12 hours, including aspiration, phenylephrine use, and when to escalate to surgical shunting. Broderick reinforces that every minute counts, sharing insights from decades of resident training and why aspiration should be performed until bright red blood returns—signaling better oxygenation and a higher chance of pharmacologic success. The conversation also touches on the blurred lines between urology clinics and online or non-specialist men’s health centers. With compounded GLP-1s leaving the market, Pearlman and Broderick anticipate an increase in ED treatments from non-urologists and warn of the risks that come with uncontrolled injection protocols. They underscore the importance of ownership—if you're initiating penile injections, you're responsible for teaching, titrating, and reversing them safely. Looking ahead, the panel stresses collaboration, not criticism, when it comes to non-traditional ED care providers. Their message: priapism is rare, but when it happens, there’s no room for delay, denial, or delegation.

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“What did the council decide on item 42?” — answered with the speaker and the moment.

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