Abstract
Ischemic priapism must be expeditiously treated to prevent corporal fibrosis, penile shortening, and erectile dysfunction. Medical therapy with corporal aspiration and irrigation is a useful first-line therapy, but in refractory cases, invasive procedures are typically necessary. Though sometimes effective, shunt surgeries are not universally successful in achieving detumescence and exacerbate corporal scarring, which makes subsequent penile prosthesis insertion more difficult. Insertion of a penile prosthesis during an acute episode of refractory, ischemic priapism alleviates pain and allows the patient to resume sexual function earlier. It also obviates the corporal scarring that may significantly shorten the penis and complicate subsequent prosthesis insertion.
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References
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Broderick GA. Priapism. In: Walsh PC, Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell's Urology 10th Ed, 2011;1(25):749–769
Rees RW, Kalsi J, Minhas S, Peters J, Kell P, Ralph DJ. The management of low-flow priapism with the immediate insertion of a penile prosthesis. BJU Int. 2002;90:893–7.
Sedigh O, Rolle L, Negro CL, et al. Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature. Int J Impot Res. 2011;23:158–64. This paper nicely describes the difficulty in delayed prosthetic insertion following ischemic priapism and resultant corporal scarring.
Salem EA, El Aasser O. Management of ischemic priapism by penile prosthesis insertion: prevention of distal erosion. J Urol. 2010;183:2300–3.
El-Bahnasawy MS, Dawood A, Farouk A. Low-flow priapism: risk factors for erectile dysfunction. BJU Int. 2002;89:285–90.
Kelami A. Implantation of Small-Carrion prosthesis in the treatment of erectile impotence after priapism: difficulties and effects. Urol Int. 1985;40:343–6.
Bertram RA, Carson 3rd CC, Webster GD. Implantation of penile prostheses in patients impotent after priapism. Urology. 1985;26:325–7.
Douglas L, Fletcher H, Serjeant GR. Penile prostheses in the management of impotence in sickle cell disease. Br J Urol. 1990;65:533–5.
Monga M, Broderick GA, Hellstrom WJ. Priapism in sickle cell disease: the case for early implantation of the penile prosthesis. Eur Urol. 1996;30:54–9.
Montague DK, Jarow J, Broderick GA, et al. American Urological Association guideline on the management of priapism. J Urol. 2003;170:1318–24.
Pohl J, Pott B, Kleinhans G. Priapism: a three-phase concept of management according to aetiology and prognosis. Br J Urol. 1986;58:113–8.
Broderick GA, Harkaway R. Pharmacologic erection: time-dependent changes in the corporal environment. Int J Impot Res. 1994;6:9–16.
Nehra A. Priapism. Pathophysiology and non-surgical management. In: Porst HBJ, editor. Standard Practive in Surgical Medicine. Boston: Blackwell Publishing; 2006. p. 174–9.
Spycher MA, Hauri D. The ultrastructure of the erectile tissue in priapism. J Urol. 1986;135:142–7.
Ul-Hasan M, El-Sakka AI, Lee C, Yen TS, Dahiya R, Lue TF. Expression of TGF-beta-1 mRNA and ultrastructural alterations in pharmacologically induced prolonged penile erection in a canine model. J Urol. 1998;160:2263–6.
Lue TF, Pescatori ES. Distal cavernosum-glans shunts for ischemic priapism. J Sex Med. 2006;3:749–52.
Burnett AL. Surgical management of ischemic priapism. J Sex Med. 2012;9:114–20. This paper is a thorough review of the surgical management of priapism.
Zacharakis E, Raheem AA, Freeman A, Skolarikos A, Garaffa G, Christopher AN, et al. The efficacy of the T shunt procedure and intracavernous tunneling (snake manouver) for the management of refractory ischaemic priapism. J Urol. 2013. doi:10.1016/j.juro.2013.07.034.
Tausch TJ, Mauck R, Zhao LC, Morey AF. Penile prosthesis insertion for acute priapism. In: Morey AF, Hudak SJ, eds. Urologic Clinics of North America: Urologic Trauma and Reconstruction, Aug 2013; 40(3):421–425. This chapter provides an overview and algorithm for treating patients with acute, ischemic priapism by immediate insertion of a penile prosthesis.
Nixon RG, O'Connor JL, Milam DF. Efficacy of shunt surgery for refractory low flow priapism: a report on the incidence of failed detumescence and erectile dysfunction. J Urol. 2003;170:883–6.
Brant WO, Garcia MM, Bella AJ, Chi T, Lue TF. T-shaped shunt and intracavernous tunneling for prolonged ischemic priapism. J Urol. 2009;181:1699–705.
Segal RL, Readal N, Pierorazio PM, Burnett AL, Bivalacqua TJ. Corporal Burnett "snake" surgical maneuver for the treatment of ischemic priapism: long-term followup. J Urol. 2013;189:1025–9.
Tausch TJ, Evans LA, Morey AF. Immediate insertion of a semirigid penile prosthesis for refractory ischemic priapism. Mil Med. 2007;172:1211–2.
Ralph DJ, Garaffa G, Muneer A, et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur Urol. 2009;56:1033–8.
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Allen F. Morey has received payment for development of educational presentations (including service on speakers’ bureaus) from Coloplast, American Medical Systems and GlaxoSmithKline.
Timothy J. Tausch, Jordan Siegel and Ryan Mauck declare that they have no conflict of interest.
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This article is part of Topical Collection on Male and Female Surgical Interventions
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Tausch, T.J., Siegel, J., Mauck, R. et al. Role of Penile Prosthesis Insertion in the Treatment of Acute Priapism. Curr Sex Health Rep 6, 45–49 (2014). https://doi.org/10.1007/s11930-013-0009-z
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DOI: https://doi.org/10.1007/s11930-013-0009-z