O-13 Venous Priapism with More than 36 Hours of Evolution - Description of Management and Outcome of 05 Cases Treated in the State of Paraná – Brazil

Abstract

Venous priapism is an infrequent urological emergency. Its management with less than 8 hours of evolution has good resolution rates with aspiration, washing and irrigation of the corpora cavernosa. The management of patients with priapism with more than 36 hours of presentation is challenging, with high rates of recurrence and erectile dysfunction. The late implantation of penile prostheses in post-priapism patients is technically difficult due to the intense fibrosis of the corpora cavernosa. Our publication aims to report the management of five patients attended with priapism with more than 36 hours of evolution. Of the five patients, two were submitted to aspiration, washing of the corpora cavernosa, Winter and Al-Ghorab procedures. One of them underwent Quakels's procedure and other Snake's procedure. None of them had complete resolution of priapism and both had erectile dysfunction refractory to oral medication. Two patients received penile implants. Implants placed at 7 and 35 days of presentation of priapism, during the period of involuntary erection. Both had resolution of the pain and did not present postoperative complications. There was no technical difficulty in the penile implant of these two patients. The fifth patient had an initial approach with aspiration, washing and cavernous irrigation with vasoactive solution, followed by Winter and Al-Ghorab procedure. There was persistence of priapism. Then it was decided to implant a penile prosthesis in the same hospital, which culminated in the extrusion of one of the penile implants through the Al-Ghorab orifice through the glans and local infection. Patient had his penile implants removed, drainage and intravenous antibiotic therapy. A critical analysis of the cases treated suggests that the penile implant is an initial and definitive way in the management of venous priapism with more than 36 hours of evolution, it is adequate to treat priapism and the probable sequelae of erectile dysfunction due to late priapism.