Outcomes of low-flow priapism and role of integrated penile prosthesis management

Mamdouh M Elhawy,A M Fawzy

doi:10.1186/s12301-020-00114-w

Abstract

BackgroundThe natural history of priapism and predictors of erectile dysfunction (ED) remain vague due to defective reporting, different management techniques and variable follow-up durations. Acquiring more information concerning the prognosis of erectile function after priapism can help to assess the burden of post-priapism ED. Also, it may guide the decision-making process regarding penile prosthesis insertion in refractory and late post-priapism ED. In this study, we tried to evaluate the state of erectile function after recovery and how far penile implant surgery could be integrated in the early and late management of priapism-related ED.MethodsWe included 72 patients with low-flow priapism who were managed via a stepwise approach starting from aspiration through percutaneous distal shunt up to distal shunt. Immediate placement of a penile prosthesis was completed in eight refractory patients, including three that were inserted even before an open distal corporoglanular shunt.ResultsNearly two-thirds (70.3%) of recovered priapism patients developed ED, but penile prostheses were inserted only in 35.5% of ED cases. There were no differences in the short- and long-term complications of immediate versus delayed prosthesis placement except for difficulty with the insertion of the penile prosthesis in delayed procedures.ConclusionsImmediate placement of a penile prosthesis is a good treatment option in the setting of refractory priapism with comparable outcomes to those of patients with post-priapism ED who received prostheses. Immediate penile prosthesis insertion was further justified by the high incidence of post-priapism erectile dysfunction.

Highlights

The natural history of priapism and predictors of erectile dysfunction (ED) remain vague due to defective reporting, different management techniques and variable follow-up durations
In 47% of cases, the cause of priapism was not identified and the case was classified as idiopathic, followed by ICI during penile duplex ultrasound in 33.3% and 19.4% appearing after ICI home therapy (Table 1)
Aspiration with or without injection of vasoactive agent was the most commonly used modality, with recovery in 45 cases (62.5%), followed by percutaneous distal shunt in 17 cases, including three that were unresponsive and who progressed to immediate penile prosthesis placement

Summary

Introduction

The natural history of priapism and predictors of erectile dysfunction (ED) remain vague due to defective reporting, different management techniques and variable follow-up durations. Acquiring more information concerning the prognosis of erectile function after priapism can help to assess the burden of post-priapism ED. It may guide the decision-making process regarding penile prosthesis insertion in refractory and late post-priapism ED. We tried to evaluate the state of erectile function after recovery and how far penile implant surgery could be integrated in the early and late management of priapism-related ED. Aphrodite gave birth to Priapus, a misshapen dwarf with a large, erect penis. This myth expresses the mysterious nature of priapism till [1]. Low-flow priapism, known as ischaemic priapism, is a persistent unwanted painful erection that lasts

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