Clinical Guidelines for Priapism\Clinical Guidelines for Priapism-Reply

Fantus et al appreciate the Letter to the Editor from Holzman noting the potential value of ketamine in the therapy of priapism. This therapy was not discussed in the recent American Urological Association priapism guidelines; the evidence is limited and based on case reports mentioned by Holzman as well as others. Zipper et al presented a series of 4 pediatric patients and reported priapism resolution in each of 3 patients with a priapism event of less than 12 hours' duration. However, other reports on ketamine are mixed, even in the perioperative setting, where its use was first reported, and standard treatment protocols remain to be established. Recent investigations have attempted to elucidate the mechanism by which ketamine might affect erectile function in mice and concluded that N-methyl-D-aspartate receptor antagonism may be responsible via decreased parasympathetic transmission and decreased relaxation of the corpus cavernosum smooth muscle tissue.