Early versus delayed penile prosthesis insertion for refractory ischemic priapism

Abstract

Objectives Penile prosthesis insertion is a well-established therapeutic option in refractory ischemic priapism but there is a lack of standardization regarding the timing of surgery, the type of prosthesis (malleable or inflatable), as well as the possible complications. In this study, we retrospectively compared early versus delayed penile prosthesis insertion in patients with refractory ischemic priapism. Methods 42 male patients who presented with refractory ischemic priapism during the period between January 2019 and January 2022 were included in this study. All patients had malleable penile prosthesis insertion by four highly experienced consultants. Patients were divided into two groups based on the time of the prosthesis insertion. 23 patients had immediate insertion of the prosthesis within the first week of the onset of priapism while the remaining 19 patients had delayed prosthesis insertion three months or later after the onset of priapism. The outcome as well as the intra- and the postoperative complications were recorded. Results Postoperative complications such as prosthesis erosion and infection were higher among the early insertion group while the delayed insertion group had higher incidence of intraoperative complications such as corporal perforation and urethral injury. The insertion of the prosthesis was much more difficult among the delayed insertion group due to fibrosis which made dilatation of the corpora very difficult. The length and the width of the penile implant were significantly higher among the early insertion group as compared to the delayed insertion group. Conclusions Early penile prosthesis insertion for refractory ischemic priapism is a safe and effective treatment option as delayed prosthesis insertion is more difficult and challenging due to corporal fibrosis and is associated with higher complication.

Penile prosthesis in priapism: a systematic review of outcomes and complications

“…Most of the studies describe the outcomes of an early PP implant; however, Durazi et al describe the results in a delayed approach to PP implant, and some of the papers do not specify the time when the prosthesis was implanted (early or delayed) ( 9 - 12 , 14 ). Of these selected papers, five compare the outcomes of early placement (EP) vs. delayed placement (DP) PP implants after priapism ( 8 - 11 , 26 ).…”

“…Additionally, in a study conducted by Zacharakis [2014] with a sample size of 68 participants (n=68; 100%), EP was defined similarly to Elhawy’s approach ( 10 , 11 ). Finally, Salman [2023] undertook research with a sample size of 42 participants, accounting for 55% of the total, and classified EP as implantation during the first week following the occurrence of priapism ( 8 ). Figure 2 shows the frequency of MPP and inflatable PP (IPP) in the EP or DP settings, as described by Johnson, Zacharakis, and Salman ( 8 - 10 ).…”

“…Most of the patients had a MPP implant either early or delayed after the priapism episode, Figure 3 shows the relation between the number of IPP and MPP in the different papers. Only two studies used a higher number of IPP compared to MPP—Uberoi et al of a series of eight patients, seven had a three-piece IPP implant, and only one had an MPP ( 8 , 14 - 16 , 21 , 22 ) and Sedigh et al had only one MPP implant vs. four IPP ( 23 ). Zacharakis et al [2015] describe a series of 10 patients with early MPP implant after priapism with later exchange to IPP ( 16 ).…”

“…The most frequently reported complications following PP procedures include infection (range, 6–50%), erosion (range, 1–9%), curvature (range, 1–10%), and mechanical issues with the device, such as malfunction or auto-inflation (range, 2–5%) ( 8 - 11 , 14 - 16 , 19 , 24 , 27 ). Sedigh [2011] and Vagnoni [2019] found that all patients initially experienced a decrease in penile sensitivity, but this was a temporary side effect ( 22 , 23 ).…”

“…Of particular significance is the scarcity of published literature concerning the optimal timing for PP implantation in priapism cases. Immediate implantation is considered to have a greater risk of infection compared to delayed implantation ( 8 ). Nevertheless, a consensus on the precise timeline distinguishing immediate, early, and delayed implantation remains elusive.…”