V8-13 ACUTE INSERTION OF PENILE PROSTHESES FOR REFRACTORY ISCHEMIC PRIAPISM

Abstract

You have accessJournal of UrologyBladder Oncology/Testis/Transplantation/Trauma1 Apr 2015V8-13 ACUTE INSERTION OF PENILE PROSTHESES FOR REFRACTORY ISCHEMIC PRIAPISM Paul Chung, Timothy Tausch, Jordan Siegel, James Flemons, and Allen Morey Paul ChungPaul Chung More articles by this author , Timothy TauschTimothy Tausch More articles by this author , Jordan SiegelJordan Siegel More articles by this author , James FlemonsJames Flemons More articles by this author , and Allen MoreyAllen Morey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2137AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with refractory ischemic priapism (RIP) frequently develop severe erectile dysfunction (ED) and ultimately require penile prosthesis insertion. We describe the technique of malleable penile prosthesis (MPP) insertion in the acute setting of refractory ischemic priapism. METHODS We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007-2013. Data analyzed included duration of erection, number of ER visits, hospital admissions, days of hospitalization and postoperative course. Costs were estimated using standard Medicare reimbursement rates. Surgery began with a 2-in longitudinal penoscrotal incision due to the need for larger corporotomies necessary to facilitate MPP insertion. Three pairs of traction sutures of 2-0 PDS were placed along each corporal body. A 3-cm corporotomy was made, allowing for escape of ischemic blood and irrigation of clot. Rosello cavernotomes (Coloplast, Minneapolis, MN) were used to sequentially dilate the corpora and remove damaged intracavernosal tissue. To minimize the risk of distal erosion, the MPP was undersized by 1 cm, so that the cylinder tip resided just proximal to the coronal sulcus. A drain was placed overnight. The corporotomies and wound were closed in multiple layers with absorbable sutures. RESULTS During the study period, 14 men underwent MPP placement acutely for refractory priapism for sickle cell anemia, medication-induced or idiopathic RIP. Average preoperative duration of RIP was 82 hours (range 3.5-240) with considerable consumption of health care resources [average $83,818 estimated cost, 4 emergency room visits (range 1-27), 2 hospital admissions (range 1-5), 1.5 shunt procedures (range 1-3), 5 irrigation and drainage procedures using phenylephrine injection (range 2-20) and 5 hospital admission days (range 2-14)]. All patients were discharged within 24 hours of MPP surgery. CONCLUSIONS MPP insertion is efficacious for the immediate resolution of RIP and treatment of ED, which subsequently develops in many patients. MPP also has potential cost and resource benefits. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e719 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul Chung More articles by this author Timothy Tausch More articles by this author Jordan Siegel More articles by this author James Flemons More articles by this author Allen Morey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...