SEXUAL DISORDERS Our experience in the treatment of priapism

Abstract

Priapism is a persistent erection without sexual stimulation that cannot be relieved by orgasm. Its etiology includes the impaired mechanism of detumescence caused by the abundant release of neurotransmitters, venules obstruction, impairment of the intrinsic mechanism of detumescence, or prolonged relaxation of the intracavernous smooth muscles. Treatment of priapism is conservative, pharmacological, or surgical. Efficient treatment options include the intracavernous vasoconstrictor injections or surgical shunting. Alternative treatment options include the intracavernous methylene blue injections or selective penile arterial embolization. Between 2001 and 2009, we treated 10 patients with priapism at our clinic. According to our data, priapism as a complication after intracavernous administration of prostaglandin E1 occurs in 2.7% of patients, after additional administration of prostaglandin E1 and phentolamine – in 5.0% patients, after administration of papaverine – in 8.3% patients. The obtained results allow recommendation of prostaglandin E1 as a medication of choice among the vasoactive substances for intracavernous use due to high efficacy and low side effects. Initially all cases of priapism must be treated pharmaceutically, but can be converted to surgery as needed. Unilateral transcaputal puncture of the cavernous body (shunting after Winter) in our patients with ischemic priapism allowed to achieve detumescence in 100% of cases without subsequent recurrence and to restore erectile function in 30% of patients.

Outcome and erectile function following treatment of priapism: An institutional experience

“…Some are idiopathic. [ 9 10 11 12 13 ] In our series, all the cases were of ischemic type with varied etiologies. Mean duration of priapism was 96.7 h. Late presentation to medical facilities was due to patient's embarrassment and poor knowledge about the condition attributed to this prolonged duration of priapism at presentation.…”

Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism: a systematic review by the EAU Sexual and Reproductive Health Guidelines panel

“…Detumescence rates varied among studies depending on the time interval between IP onset and shunt surgery. In 5 studies ( (14,(17)(18)(19)45)) where median IP duration was ≤36 hours, success rates ranged between 77.7 and 100%. An overall complication rate of 18%.…”

Acute Ischemic Priapism: An AUA/SMSNA Guideline

“…Analysis of the literature has shown that scalpel-based shunts (eg, Ebbehoj, Al Ghorab, Lue T Shunt) provide higher success than needle-based (ie, Winter's) shunts. 5,15,18,24–38 Another potential factor relevant to comparative success rates is duration of priapism prior to the intervention of interest. In one study of patients managed with tunneling, detumescence was achieved in 100%, 34%, and 0% of cases treated before 24 hours, at or beyond 48 hours, and at or beyond 96 hours, respectively.…”