Priapism Research Articles

Surgical Management of Ischemic Priapism: what are the New Options?

Ischemic priapism is a true urologic emergency. Prompt intervention is required to alleviate the compartment syndrome and restore perfusion to the corporal bodies; failure to do so results in irreversible damage, fibrosis, and profound erectile dysfunction. This paper's objective is to review current literature surrounding the management options for ischemic priapism, focusing on newer surgical techniques. A PubMed database search was performed in June 2024, encompassing the terms "priapism," and "surgical management." Articles were reviewed by two authors independently and included if they were deemed to pertain specifically to management of ischemic priapism. In the acute setting (certainly for priapism lasting <24 hours), management is often successful using bedside maneuvers such as aspiration, irrigation, and injection of sympathomimetic agents. For more prolonged priapism, more aggressive intervention is often warranted. Newer tunneling techniques-including penoscrotal decompression and the corporal snake maneuver-have shown promising preliminary results, not just in terms of priapism resolution but also perhaps sexual function recovery.

CHARACTERISTICS OF PRIAPISM PATIENTS AT ARIFIN ACHMAD HOSPITAL RIAU PERIOD 2017-2021

Objective: To find out the description of the characteristics of Priapism patients. Material &amp; Methods: This research used a total priapism patients in Arifin Achmad Hospital, Riau Province from January 2023 to February 2023. Results: From 7 patients with priapism who met the inclusion and exclusion criteria, most age group were from the 36-45 year age group in 3 (42.9%) patients. History of disease in patients with most priapism was leukemia in 3(42.9%) patients. Conclusion: Classification of ischemic priapism were in 4 (57.1%) patients and non-ischemic priapism was 3 (42.9%) patients and all management of priapism patients was carried out by surgery (100%). Keywords: Priapism, leukemia, management of priapism.

MODERN APPROACHES IN DIAGNOSTIC AND TREATMENT OF PRIAPISM IN MEN INJURED AS A RESULT OF COMBAT ACTIONS

Introduction. Priapism is a frequent painful erection that lasts more than 4 hours and is not caused by sexual stimulation, occurs when blood is blocked in the penis and cannot leave it. It is believed that the increase in the frequency of priapism directly depends on the prevalence of intracavernous injections of vasoactive substances in the treatment of erectile dysfunction. Aim. To evaluate the pathogenetic features of the development of priapism, as one of the forms of sexual dysfunction, in men injured as a result of combat operations (combat trauma) and to optimize treatment methods. Materials and methods. The study included 14 priapism patients who were treated at the urology clinic in 2022-2024. Priapism as a complication developed in 2 (4.4%) of 45 patients after intracavernous injection of 20 μg of prostaglandin E1 (PGE1) (group 1), in 1 (10%) of 10 patients after sequential injection of 20 μg of PGE1 and 0,5 mg of phentolamine (group 2), in 3 (20%) of 15 patients after injection of 2% solution papaverine (group 3). In 5 patients, priapism occurred against the background of systematic use of anticoagulants (low molecular weight heparin) in the treatment of severe vascular pathology (phlebothrombosis, thrombophlebitis) (group 4). In another 3 patients, the cause that led to priapism was not found, so the idiopathic form was established (group 5). Results. It was shown that in 3 cases, the duration of priapism in patients with psychogenic ED was insignificant, since all patients were warned about the possible development of priapism before the injection of the vasoactive drug and recommended to seek medical help immediately in case of its occurrence. Three out of three patients with a previous diagnosis of mixed erectile dysfunction (with an organic vascular component) failed to restore erectile function after shunting. Three out of four patients diagnosed with idiopathic priapism reported the absence of erections during several months of postoperative follow-up. In no case was there a recurrence of priapism in the postoperative period. Conclusions. The obtained data allow us to recommend prostaglandin E1 as the drug of choice among vasoactive substances for intracavernous use due to its highest safety. Unilateral transcaputal puncture of the cavernous body (Winter shunt) in patients with ischemic priapism made it possible to achieve detumescence in 100% of cases without subsequent recurrence and restore erectile function in 40% of patients.

A contemporary review of the management strategies for sickle cell disease related ischaemic and stuttering priapism.

Sickle cell disease is one of the most common autosomal recessive genetic disorders with 23% and over 70% of men with this condition, experiencing episodes of ischaemic priapism and stuttering priapism, respectively, with potentially severe consequences. The effective prevention of sickle cell disease induced ischaemic priapism and stuttering priapism requires a multidisciplinary and multimodal approach. A search of the English literature was performed utilising Pubmed® and Google Scholar to identify publications on contemporary and novel treatment options, with their associated treatment outcomes if available, that are utilised to prevent stuttering priapism episodes and hence a fulminant ischaemic priapism. This narrative review focuses on three main aspects which include firstly, patient education and lifestyle modifications. Secondly, strategies aimed at preventing stuttering priapism episodes with traditional treatments such as alpha-adrenergic agonists and hormone manipulation strategies among others. Finally, we review treatments utilised to treat the underlying sickle cell disease with contemporary options such as hydroxyurea to more novel therapies such as crizanlizumab and voxelotor. The role of potentially curative techniques such as gene therapy and stem cell transplantation are also reviewed and summarised.

The assessment and aetiology of drug-induced ischaemic priapism.

Ischaemic priapism is a urological emergency characterised by a prolonged, painful erection unrelated to sexual stimulation. While several aetiological factors contribute to this condition, the pharmacological causes have gained significant attention in recent years. This narrative review aims to comprehensively assess ischaemic priapism, specifically focusing on its pharmacological aetiology. We propose an approach and assessment strategy to the numerous factors associated with pharmacologically induced ischaemic priapism. By enhancing our understanding of the pharmacological causes of this condition, healthcare professionals can improve patient management and reduce the long-term complications associated with ischaemic priapism.

Treatment of recurrent priapism using proximal shunt: Quackles technique

IntroductionRecurrent priapism is a rare variant of ischemic priapism that involves recurrent erections typically lasting less than 4 h. The primary goal of treatment is to prevent future episodes, with options ranging from pharmacological treatments to various surgeries.Case presentationA 38‐year‐old man experienced multiple episodes of priapism that were refractory to angioembolization of an arteriocavernous fistula and oral treatment with Cetirizine and Bicalutamide. After the patient refused intracavernous self‐injections, various surgical options were considered. Ultimately, a proximal penile shunt surgery with a cavernosal–spongiosal shunt using the Quackles technique was chosen, which proved effective in preventing episodes and did not affect the patient's erectile function.ConclusionPenile shunt surgery using the Quackles proximal technique is a safe and effective option for the treatment of recurrent priapism.

Idiopathic recurrent ischemic priapism: a review of current literature and an algorithmic approach to evaluation and management

BackgroundStuttering priapism is characterized by recurrent, self-limited episodes of penile erection lasting from a few minutes to a maximum of three hours, often resolving spontaneously. These episodes can occur with or without sexual stimulation. If not treated promptly and effectively, stuttering priapism can severely impact a patient’s quality of life, leading to significant psychological distress and anxiety related to sexual performance. Although it has been associated with various hematological disorders and pharmacological treatments, many cases of stuttering priapism remain idiopathic, meaning they have no identifiable cause. Currently, no conclusive randomized clinical trials exist on the management of idiopathic stuttering priapism. This study aims to review the existing literature on the pathophysiology and management of idiopathic stuttering priapism and propose an algorithm to assist physicians in its evaluation and treatment.ResultsA systematic literature review was conducted using the PubMed database, focusing on the terms “idiopathic,” “stuttering,” “ischemic,” and “priapism.” The search identified 23 relevant references published between 1991 and 2022. The selection and analysis of these studies adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and results were described qualitatively. Recent research into the effectiveness, sustainability, tolerability, and side effects of various treatments for idiopathic stuttering priapism has enhanced the understanding of its underlying molecular mechanisms. Various treatments, targeting different mechanisms, have been identified that can potentially reduce the frequency and severity of episodes and improve patient outcomes.ConclusionCurrent research predominantly addresses the acute treatment of idiopathic stuttering priapism rather than strategies to alter the disease’s overall course. The limited number of treatment reviews, case reports, and the low level of evidence available, combined with the absence of randomized clinical trials, prevent the establishment of a consensus on treatment protocols. As a result, idiopathic stuttering priapism remains under-recognized and under-treated. This review proposes a management framework to help clinicians access and apply the available literature effectively, minimizing the reliance on extensive case reports and review articles.

Sympathetic hypoactivity leads to hypocontractility of the corpus cavernosum in sickle cell mice: a mechanism contributing to priapism.

Priapism, a prevalent complication in sickle cell disease (SCD) patients, manifests as prolonged and painful erections unrelated to sexual arousal. The detailed mechanisms contributing to this condition, especially regarding sympathetic function in the corpus cavernosum that maintains penile flaccidity, remain to be elucidated. In this study, it was hypothesized that the pathways of the sympathetic nervous system would be down-regulated, thereby contributing to the development of ischemic priapism in sickle cell disease. This study aimed to investigate the contractions induced by stimulation of sympathetic terminals and the expression of tyrosine hydroxylase in the corpora cavernosa of Berkeley SCD mice. C57BL/6 mice (wild-type, WT) and Berkeley SCD mice were used. A total of 22 mice were used in this study, with 11 allocated to the WT group and 11 to the SCD group. Mice corpus cavernosum was dissected free and mounted in 7-mL organ baths containing Krebs solution. Noradrenergic contractions were obtained using electrical-field stimulation (4-32 Hz) in corpus cavernosum strips from WT and SCD mice. Measurements of tyrosine hydroxylase phosphorylated at Ser-31 and total tyrosine hydroxylase protein expressions in cavernosal tissues were also measured by western blot. The neurogenic contractions were significantly lower (P < 0.05) in the SCD group compared to WT group at all tested frequencies. The protein expression of both total tyrosine hydroxylase and tyrosine hydroxylase phosphorylated at Ser-31 was significantly decreased by approximately 46.28% (P = 0.01) and 55.32% (P = 0.03) in cavernosal tissues from the SCD group compared to the control group, respectively. In conclusion, sympathetic hypoactivity characterized by the downregulation of tyrosine hydroxylase contributes to the hypocontractility of the corpus cavernosum in Berkeley SCD mice. This suggests an impairment in the mechanism responsible for maintaining penile flaccidity, potentially predisposing to erections without sexual stimulation, similar to those observed in ischemic priapism. Pharmacological treatments aiming to restore sympathetic tone in the penis might hold promise for addressing ischemic priapism in SCD.

Intracavernosal mesenchymal stem cell therapy in ischaemic priapism: an experimental study.

The most common form of priapism is ischaemic and its prevalence in men has increased in recent years as a result of intracavernosal drug use. Currently, there is no approved specific treatment for ischaemic priapism other than cavernosal aspiration, which can only provide detumescence. This study aims to evaluate the efficacy of intracavernosal mesenchymal stem cell (MSC) therapy in an ischaemic priapism model. Thirty male Wistar albino rats were divided into three groups: sham (n = 6), priapism (n = 12) and priapism + MSC treatment (n = 12). The experimental groups were also divided into 1 and 12h subgroups of ischaemic priapism. The experimental model was created using a vacuum erection device and constrictive tape technique, and intracavernosal MSC were applied immediately after the tape was removed. After 4weeks, intracavernosal pressures (ICPs) and systemic mean arterial pressure (MAP) were measured. Penectomy was then performed to assess histopathological and molecular changes in the rats' penile tissues. In the ischaemic priapism model, MSC therapy showed significant improvements in peak and mean ICPs and mean ICP/MAP ratio. Histopathological analysis showed significant increases in smooth-muscle/collagen ratio and e-NOS and n-NOS expression. Although there was a decrease in fibrosis, it was not significant. At the molecular level, there were significant decreases in TGF-beta and VEGF mRNA expression, whilst NGF and BDNF mRNA-expression levels showed significant increases with MSC therapy. In terms of ICPs, the therapy showed more significant improvements in short-term priapism. However, when looking at histopathological and molecular parameters, the therapy had positive effects on a wider range of parameters in the long-term priapism. MSC treatment improved cavernosal physiology and had positive effects at the histopathological and molecular level in the ischaemic priapism model.

Priapism in South West Nigeria—Short and Intermediate-Term Outcomes

Abstract Background: Priapism is usually defined as penile erection that lasts more than 4 h beyond sexual stimulation and orgasm or is unrelated to sexual stimulation. The overwhelmingly more common low-flow priapism is typically painful, while high-flow priapism is typically painless. Interventions are varied depending on the aetiology and timing of the presentation. The outcome in most cases depends on the timing of the intervention. Objective: This study aimed to review the presentation and short- and intermediate-term outcomes of treatment of priapism in patients in Southern Nigeria. Materials and Methods: This was a retrospective 10-year study conducted from 2010 to 2019 of all adult patients diagnosed with priapism who were admitted to the adult urology units in two Government University Teaching hospitals in South West Nigeria. Results: The records of 61 patients were analysed. The mean age was 27.54 years ± 6.22 with a range of 15–56 years. The median duration of symptoms before presentation was 36 h with a range of 2 to 336 h. Eleven patients (18%) presented within 24 h of onset of symptoms. Sickle cell disease (SCD) and idiopathic aetiology were the most common causes of priapism, accounting for 44 (72.1%) and 8 (13.1%) respectively. Corporal aspiration resolved the priapism in 22 (36.1.%), while corpora–glandular shunt was the final treatment in 36 (59.1%). Fifty-seven per cent had erectile dysfunction (ED), while penile gangrene with autoamputation was observed in one patient (1.6%). Sixty-six per cent and 62% of patients who presented within &lt; 36 h and 36–72 h, respectively, experienced normal erection at 6 months after surgery. Erectile function got progressively worse after 72 h, with all patients with ischemic priapism lasting more than 1 week developing ED. There was no statistically significant relationship between the variants of SCD and the risk of ED in patients who presented within 72 h. Conclusion: The incidence of ischemic priapism was high, with sickle cell disease being the most common cause. The risk of ED was significantly worse after 72 h. The aetiology of priapism did not significantly influence the risk of ED.

Corporal aspiration and sympathomimetic injection for priapism: “Preprocedure preparation” and “procedural considerations”

Priapism is a prolonged and persistent erection that lasts more than 4 hours and is unrelated to sexual stimulation. Although uncommon, it requires expeditious treatment to prevent erectile function compromise. Corporal aspiration is the first-line treatment for patients with ischemic priapism. This article focuses on contemporary corporal aspiration techniques for the management of priapism. After obtaining informed consent and administering local anesthesia, corporal aspiration was initiated by inserting 2 large-bore butterfly needles into the penile shaft. Aspiration is then performed using 10-mL syringes to decompress the corporeal pressure, flush out clots, and restore the pH balance of the penis. Diluted phenylephrine (100–1000 μg/mL) is injected in 1 mL aliquots every 5 to 10 minutes until complete detumescence is achieved. The results show that the overall resolution rate using corporal aspiration followed by phenylephrine injection is 65% to 72%. Ninety percent of men experience detumescence success if aspiration and phenylephrine injection are performed within 12 hours. Conversely, 85% of patients with priapism may require penile shunt surgery if the priapism exceeds 24 hours, and in the majority of these patients, health care providers will consider placing a penile prosthesis if the priapism exceeds 36 hours. Corporal aspiration is the first-line treatment for priapism. When properly performed expeditiously, patients experience a high rate of detumescence. Ischemic priapism is a true urological emergency that requires prompt diagnosis and treatment. The advantages of using corporal aspiration as a first-line treatment include pain relief and the prompt restoration of circulation.

Penoscrotal Decompression: A New Paradigm for Managing Prolonged Ischemic Priapism

Penoscrotal Decompression: A New Paradigm for Managing Prolonged Ischemic Priapism

Long-term experience with AMS-700 CXR inflatable penile prosthesis in high-risk patients with corporal fibrosis.

Despite the widespread use of narrow diameter inflatable penile prosthesis (IPP) cylinders in patients with corporal fibrosis, outcomes data is sparse. We evaluated patients who underwent IPP placement with AMS™ 700 Controlled Expansion Restricted (CXR) cylinders from 2007-2021. Patient characteristics, device details, and surgical outcomes were assessed. A non-validated questionnaire was also distributed to patients to assess satisfaction. Among 982 IPPs placed over the study period at our institution, 49 (5.0%) used CXR cylinders. Indications for narrow cylinders: prior explant for infection (67.3%), ischemic priapism (16.3%), and idiopathic fibrosis (16.3%). Median corporal length was 19 cm (IQR 17-21 cm). Discordant intraoperative corporal measurements (24.5%) and RTE lengths (26.5%) were common. Post-operative complications occurred in 8 patients (16.3%) and included 3 infections (6.1%), 2 cylinder herniations (4.1%), 2 mechanical failures (4.1%), and one case of glans necrosis (2.0%). Five of these (10.2%) required explantation, while 4 (8.2%) were managed with revision. Over the follow-up period, 73.5% of patients reported satisfaction with rigidity. Primary drivers of dissatisfaction were perceived loss of penile length and girth. The AMS™ 700 CXR is a useful tool for challenging corporal fibrosis cases and shows acceptable surgical outcomes with moderate patient acceptability.

Contemporary management of ischemic priapism: A 12-year population-based analysis from a large US database.

Priapism is a urological condition characterized by a persistent erection. The management varies based on its subclassifications. Despite established clinical guidelines for ischemic priapism, there is a lack of large-scale research focused on patient characteristics and management strategies. To analyze the contemporary management of ischemic priapism in the US, exploring patient demographics and clinical characteristics, as well as predictors of erectile dysfunction (ED) and penile prosthesis implantation (PPI). We performed a retrospective analysis of the PearlDiver Mariner database, reviewing records from 2010-2021. Adult males diagnosed with ischemic priapism were included. Data analysis covered demographic, clinical variables, and management strategies. Predictors of de novo ED and PPI were evaluated using multivariable logistic regression analysis. Of 36,120 patients, most (93%) received only medical management, and a minority underwent surgical interventions (penile shunt surgery [PSS], PPI or both). Medical management was typically effective, as 67.08% of the patients in this group experienced only one episode of priapism. However, de novo ED occurred in 16.57% of these patients. The majority of patients undergoing PPI had an inflatable prosthesis (81%). Older age (odds ratio, OR 1.02), the presence of metabolic diseases (OR 1.39), neurogenic disorders (OR 1.72), solid pelvic malignancies (OR 1.09), and multiple episodes of priapism were identified as significant predictors of de novo ED (all p<0.05). Similarly, age (OR 1.03), the presence of metabolic diseases (OR 1.23), solid pelvic malignancies (OR 1.99), and multiple episodes of priapism were associated with higher likelihood of PPI (all p<0.05). Most cases of ischemic priapism are managed with the medical therapy. Less than 3% of patients with ischemic priapism receive PPI, and when this occurs an inflatable prosthesis is favored. Age, specific comorbidities, and multiple episodes of priapism appear to be significant predictors of ED and PPI.

(295) EARLY PLACEMENT OF INFLATABLE PENILE PROSTHESIS FOLLOWING PENOSCROTAL DECOMPRESSION

Abstract Introduction Ischemic priapism is the most common form of priapism which accounts for up to 95% of the cases. Prolonged ischemic priapism is associated with a higher risk of corpus spongiosum fibrosis and the development of erectile dysfunction. Studies have shown that treatment of ischemic priapism under 12 hours has an excellent prognosis and may prevent erectile dysfunction in 100% of cases. On the other end of the spectrum, ischemic priapism &amp;gt;36 hours may lead to permanent loss of erectile function in virtually all cases. Objective One of the newer procedures applied in cases of refractory priapism is the penoscrotal decompression approach which is technically similar to the inflatable penile prosthesis insertion technique. In cases of failed distal shunting, this procedure has proven to be useful in small-scale studies. In this method, a penoscrotal incision is made followed by corporotomy and and corporal dilation. It is suggested that penoscrotal decompression may be favorable to early IPP placement from an economical standpoint. Methods In our experience, a 42-year-old individual presented with a prolonged episode of ischemic priapism for approximately 36 hours which did not achieve detumescence by conservative management. A shared decision was made to proceed with penoscrotal decompression. However, the patient was unable to achieve detumescence after the procedure. We decided to insert a three-piece IPP approximately 48 hours after the penoscrotal decompression procedure. A separate inguinal counter-incision was made for reservoir placement according to the established protocols for IPP placement. Results Penoscrotal decompression may not always provide favorable outcomes and maintaining erectile function by IPP implantation may be considered afterwards. Conclusions The insertion of the prosthesis following penoscrotal decompression is more challenging than the normal setting as the primary priapism leads to more blood clot formation and intracavernosal adhesion and fibrosis. Disclosure No.

(234) USING PERCUTANEOUS ULTRASOUND-GUIDED THROMBIN INJECTION AS A TREATMENT OF HIGH-FLOW PRIAPISM

Abstract Introduction Nonischemic priapism typically occurs secondary to penile trauma, resulting in increased blood flow into the penis without decreased outflow resulting in a clinically non-painful, partially rigid erection. Per the American Urologic Association guidelines, surgical treatment is discouraged, and following conservative management, first line treatment is arteriography with selective arterial embolization. This procedure is generally highly successful but it does carry a risk of erectile dysfunction as well as priapism recurrence. Objective Herein we present the first known case of ultrasound guided thrombin injection in an adult for nonischemic priapism treatment after persistent priapism and arterial blush following arterial embolization. Methods A 44-year-old male presented with an eight-month history of partial tumescence and erectile dysfunction after an episode of unwitnessed loss of consciousness resulting in the subsequent development of gross hematuria and dysuria. Physical examination revealed a semi-firm penis with suspected high-flow priapism. He initially presented to the emergency department, whereby a cystogram and cross sectional abdominal imaging were unrevealing. Initial outpatient cystoscopy revealed a urethral polyp which resolved on subsequent repeat testing. Following this an outpatient penile duplex doppler ultrasound was performed demonstrating a right pseudoaneurysm at the penile base measuring 13 mm in diameter with an arteriovenous fistulous communication to the corpus cavernosum. MRI demonstrates fibrotic changes within the right corpus cavernosum and tunica albuginea indicating prior traumatic penile injury. At the time the patient had approximately 25% tumescence at rest and was only able to obtain a slightly firmer erection, but was still able to achieve orgasm. After extensive conversation and given a trial of conservative management, the patient elected to proceed with angioembolization. An angiogram was completed which demonstrated a blush of contrast in the area of the bulbourethral artery. Despite successful deployment and coil embolization of the pseudoaneurysm, there was noted continued filling of the patent pseudoaneurysm from small branched collateral vessels. The patient tolerated the procedure well, and had reduction of his baseline penile tumescence and some erectile function recovery, requiring oral phosphodiesterase-5 inhibitors. There was concern for complete occlusion of the dorsal penile artery with repeat embolization, which may ultimately worsen erectile dysfunction. He remained incompletely satisfied with response to oral therapy. Results It was ultimately decided to pursue an ultrasound guided thrombin injection, which has been reported in a handful of cases as a primary intervention for priapism. During the procedure, 200 units of thrombin was injected into the pseudoaneurysm under ultrasound guidance resulting in immediate cessation of arterial flow. Post-procedure angiography demonstrated effective resolution. Conclusions High-flow priapism is a relatively uncommon condition, managed generally with embolization as first line treatment, with success rates reported at 89 to 100% and recurrence only occurring in 30% of patients. Recurrence is generally treated with repeat embolization which has been reported to cause erectile dysfunction in 15 to 22% of cases. Percutaneous ultrasound-guided thrombin injection has the potential to be an excellent second-line treatment option for pseudoaneurysm closure in correcting nonischemic priapism, albeit with limited data, but suspected high efficacy and potentially diminished rates of erectile dysfunction. Disclosure No.

(176) DECOMPRESSION, SUBCORONAL INTERNAL SHUNT AND TUNNELING (DESIST), A NOVEL TECHNIQUE FOR PRIAPISM: BALANCING EFFICACY AND MORBIDITY

Abstract Introduction Acute ischemic priapism is a urological emergency characterized by prolonged penile erection leading to tissue ischemia and potential erectile dysfunction. Classically, refractory ischemic priapism (RIP) was managed with distal shunt procedures performed through the glans penis, sometimes in combination with corporal tunneling. While such techniques are effective in creating an outflow pathway, they result in significant trauma to the glans penis and subsequent scarring and disfigurement. Penoscrotal decompression, a newer technique which is rapidly gaining popularity, is atraumatic to the glans but does not establish a shunt for continued blood outflow, and may be challenging for surgeons not accustomed to the penoscrotal exposure. Objective Here, we describe a novel technique-named Decompression, Subcoronal Internal Shunt and Tunneling (DeSIST) designed to combine the benefits of existing methods while minimizing associated morbidity. Methods The DeSIST procedure involves a small subcoronal incision on one side of the penis to expose the distal corpus cavernosum. Controlled decompression is achieved by creating a small 1 cm incision in the tunica albuginea and evacuating clotted blood. Tunneling is then performed by passing a pediatric sucker or small 9 mm brooks dilator down the channel of the corpora, establishing an outflow tract for pressurized blood. Subsequently, nasal speculum is placed inside the corpora distally and passed to the tip of the corpora. Between the tines of the nasal speculum, an 11 blade is then passed until it is felt to cut into the distal corporal tip. This 11 blade can then be spun in a similar fashion to the classic “T-shunt,” therefore creating a small defect in the distal corporal tip, but crucially, without violating the integrity of the glans penis. Thus, the “internal” shunt is created while sparing the glans. The corporotomy is then closed. Visualization of the glans penis becoming engorged with blood after closure of the corporotomy confirms that the cavernosal-spongiosal shunt has been created. These steps can then be repeated on the contralateral side if necessary to achieve complete detumescence. Results The DeSIST technique was utilized on two patients who presented with priapism of &amp;gt;36 hours and who failed aspiration/irrigation in the emergency room and did not want immediate penile prosthesis placement. Both patients underwent the DeSIST procedure unilaterally and achieved immediate detumescence. 3 month follow up revealed adequate return of post-surgery erectile function aided by PDE5 inhibitors. Both patients evaluated the cosmetic appearance of the glans and subcoronal scar as excellent. Conclusions The DeSIST technique offers a promising alternative for the surgical management of acute ischemic priapism. This technique effectively balances the need for immediate detumescence and the establishment of an outflow shunt while significantly reducing morbidity associated with glans scarring. Further studies with larger sample sizes and long-term follow-up are warranted to establish the definitive benefits and potential limitations of this novel approach. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Andrew Sun - Consultant for Boston Scientific, Marius Pharma, Endo Pharma. Paurush Babbar - Consultant for Boston Scientific.

(011) PENOSCROTAL DECOMPRESSION IN REFRACTORY ISCHAEMIC PRIAPISM: A REVIEW AND PROPORTIONAL META-ANALYSIS OF A NOVEL TECHNIQUE WITH PROMISING RESULTS

Abstract Introduction Penoscrotal decompression (PSD) is a novel surgical technique first described by Fuchs et al. in 2018. It involves accessing the corporal bodies via a penoscrotal incision with proximal coroportomies and subsequent drainage of ischaemic blood leading to detumescence. Although PSD has been recently popularised, its outcomes have been considered encouraging when considering operative success, recurrence rates, and preservation of erectile function. Objective This review and meta-analysis aims to holistically explore all available evidence on PSD and evaluate PSD’s utility and eRicacy as a surgical approach in a) achieving detumescence, b) preventing recurrence, and c) maintaining erectile function. Methods This systematic review was done in concordance with the PRISMA guidelines. Nine databases were thoroughly searched with all literature available, excluding metaanalyses, reviews, guidelines, editorials, and expert opinions. There were no restrictions on time or language of publication. Data extraction and descriptive analysis were performed using Microsoft Excel. A meta-analysis of proportions and heterogeneity studies was carried out using R. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies, where applicable. A p-value of 0.05 was considered statistically significant. Results Of the 110 screened studies, 11 were eligible for further review. The studies include five case reports, four abstracts and two observational cohort studies, including data from 97 patients with refractory ischaemic priapism. Drug-induced priapism was the most common cause, and less than half of the patients (44.3%) had a distal shunt before PSD. PSD laterality was described in 69 patients, with 31 and 38 having unilateral and bilateral decompressions, respectively. Detumescence was achieved in 95 out of 97 participants with a pooled proportion of 91% (CI 95%: 0.84-0.95). Post-PSD recurrence occurred in a total of 12% (95% CI: 0.06-0.21). Erectile function was preserved in 51% of the patients with follow-up (95% CI: 0.39-0.62). Heterogeneity was low amongst the studies reporting the outcomes of interest. Limitations noted included: a) A small patient sample, b) Variability in decompression techniques, c) Unspecified rationale for choosing unilateral or bilateral decompression, and d) If bilateral decompression was used only after a failed unilateral decompression. Conclusions Early evidence suggests that PSD is a feasible and eRicacious surgical technique in RIP. It oRers high detumescence rates, with a lower risk of recurrence and a better erectile functional preservation rate in contrast to other surgical techniques. Moving forward, to further outline its long-term outcomes, we encourage prospective data collection with 1. A standardised surgical approach to decompression 2. Medium to long-term followup and 3. Exploration of alternative approaches, such as an infrapubic approach. Disclosure No.

A narrative review of initial treatment for ischemic priapism.

Priapism is a rare condition characterized by prolonged and often painful penile erection unrelated to sexual stimulation. Ischemic priapism, the most common subtype, requires immediate attention to prevent irreversible damage to erectile tissue. This narrative review explores the initial management strategies for ischemic priapism. Intracavernosal phenylephrine injection and aspiration with or without irrigation are recommended as first-line treatments, with alternative options available depending on clinical settings and patient factors. While guidelines offer clear recommendations for priapism lasting more than 4 h, management of shorter-duration cases remains challenging due to limited evidence.

Management of Neglected Ischemic Priapism

Management of Neglected Ischemic Priapism