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

Abstract

Background 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. 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. Methods We 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. Results Nearly 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. Conclusions Immediate 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.

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

“…Elhawy et al compared the median girths between patients who underwent EP insertion and those who received DP insertion. The median bending for the EP group was 11 mm, while for the DP group, it was 9.5 mm ( 11 ). The study also examined the occurrence of complications in these groups.…”

“…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 ).…”

“…Johnson [2019] conducted a study with a sample size (n) of 126 participants and defined the EP group as comprising 70% of the total patients, wherein surgery took place within 3 weeks of the priapism incident ( 9 ). Conversely, Elhawy [2021] investigated 24 individuals receiving malleable PP (MPP), accounting for 33% of the cohort, and considered EP to entail implantation after 72 hours, with a median implantation time of 7 days ( 11 ). 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 ).…”

“…Conversely, Elhawy [2021] investigated 24 individuals receiving malleable PP (MPP), accounting for 33% of the cohort, and considered EP to entail implantation after 72 hours, with a median implantation time of 7 days ( 11 ). 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 ).…”

“…Nevertheless, a consensus on the precise timeline distinguishing immediate, early, and delayed implantation remains elusive. Discrepancies arise from various studies, where delayed implantation is defined as occurring beyond 3 weeks, 3 months, or 4 months following the initial onset of priapism ( 9 - 11 ). Consequently, comparing outcomes and complication rates across these studies becomes challenging due to the substantial variations in the defined timelines.…”