The management of low‐flow priapism with the immediate insertion of a penile prosthesis

Abstract

Objective To evaluate the outcome of patients undergoing the immediate insertion of a penile prosthesis as a treatment for acute low‐flow priapism.Patients and methods Eight patients presenting with low‐flow priapism with a mean duration of 91 h (range 32–192) were prospectively evaluated. All had failed conservative management with the instillation of α‐adrenergic agents, and four had already undergone shunt procedures elsewhere. Immediate management consisted of the insertion of a malleable prosthesis in six patients and an inflatable prosthesis in two. One of the malleable prostheses was subsequently changed to an inflatable device.Results There were no early complications, with all patients being satisfied with the end result, and seven having sexual intercourse. One patient developed a penile deformity after surgery, cause by fibrosis around one inflatable cylinder. All patients have maintained their penile length.Conclusions Prolonged low‐flow priapism results in a variable degree of cavernosal fibrosis and a subsequent loss of penile length. The delayed insertion of a penile prosthesis can be difficult, with high complication rates. The immediate insertion of a penile prosthesis in patients with prolonged low‐flow priapism is simple and maintains penile length. This should always be offered to the patient at initial presentation, as the complication rate is low and the subsequent outcome excellent.

Investigation of cavernosal smooth muscle dysfunction in low flow priapism using an in vitro model

“…Clinical observations indicate that as the duration of low flow priapism increases, the efficacy of pharmacological agents used to induce detumescence such as a-adrenergic agonists as well as surgically created shunts is significantly impaired. 2 Failure of detumescence in prolonged low flow priapism leads to irreversible smooth muscle dysfunction and is ultimately associated with long-term erectile dysfunction. 3 Several investigators have described an in vitro model of low flow priapism utilising rabbit corpus cavernosum.…”

Our Experiences on the Management of Priapism Cases in Guidelines Perspective

“…Dezavantajları ise öncesinde özellikle distal şant yapılan hastalarda enfeksiyon ve erozyon riskinin artmasıdır. 6,25,26 Tedavi basamakları eksiksiz uygulanan dört hastamızda T-şant operasyonuna rağmen priapizmin devam etmesi nedeni ile, erken dönemde penil protez implantasyonu yapılmış ve herhangi bir komplikasyonla karşılaşılmamıştır.…”

Priapism: what to do?

“…As a result, early period penile prosthesis implantation was recommended in schemic priaplism treatment lately. 33 Penile prosthesis was implanted in 8 days in average to 27 ischemic priapism patients in the study by Kumar et al 34 at the beginning Mentor malleable prosthesis was installed in 25 patients and then nine of these were changed with three-piece inflatable prosthesis. As the result of a nearly 17-month follow-up, all patients were reported to be satisfied and have a normal erectile function, only two undesired side effects (infection and curvature) were reported.…”