Al‐Ghorab Shunt Plus Intracavernous Tunneling for Prolonged Ischemic Priapism

Abstract

To investigate the efficacy and safety of the corpus cavernosum-corpus spongiosum shunt (Al-Ghorab Shunt) plus intracavernous tunneling (CC-CSS+ICT) for prolonged ischemic priapism (PIP). Twelve patients with PIP were enrolled in this study. The mean age of patients was 38.3 6 9.2 years old and the mean duration of PIP was 2.8 6 1.0 days (range, 1.5-4 days). All patients received CC-CSS+ICT for treating PIP. The penile hardness score (PHS) and pain visual analogue score (PVAS) were used to assess the efficacy of the surgery 1, 3, and 5 days after surgery. Color duplex Doppler ultrasonography, International Index of Erectile Function, and quality of life (QOL) were used for evaluating penile morphology, erectile function, QOL, and response to sildenafil treatment. The mean duration of follow up was 21.6 6 10.1 months. Penile detumescence was successfully restored for all 12 patients postsurgery, with the mean PHS and PVAS significantly decreased compared with that presurgery at different time points (1, 3, 5 days postsurgery; P , .001). The cavernosal arterial blood flow observed with the mean PSV at 1, 3, and 5 days postoperation were 17.79 6 2.04, 19.14 6 1.58, and 7.73 6 2.02 cm/s respectively. All patients suffered from corpus cavernosum fibrosis and erectile dysfunction postoperation; only 2 cases (16.7%) with a short duration of PIP (1.5 days) showed response to sildenafil treatment, and 3 cases (25.0%) with severe fibrosis were satisfied with sexual life after excision of penile corpus cavernosum scar and penile prosthesis implantation. The CC-CSS+ICT could quickly reduce penile rigidity and pain for improving the symptoms of PIP and suggests a safe and effective therapeutic method for PIP.

Priapism: what to do?

“…The incision can be done by sliding the incision from corpus cavernosa to the closed edge of tunica albuginea. 25 Although Al-Ghorab shunt is the most effective among distal shunts, it was observed that width invasive and impotence ratio were highest in the report. Some leaders recommend that this shunt is made after trying Winter's and Ebbehoj shunt.…”

“…So, the authors modified the shunt and intracavernous dilatation methods in lengthened ischemic priapism and demonstrated that intracavernous tunnel method done by using Corpus Cavernosum-spongiozum + hegar bougies was better than other methods [CC-CSS shunt + ICT]. 25 Burnett et al aimed the mobilization of the blood from penis proximal to the distal using hegar bougies no 7 and 8 along a few centimeters towards the inside of cc in a technique they modified al-ghorab shunt. They also defend that distal shunt activity will increase due to dilatator usage.…”

A literature review of antithrombotic and anticoagulating agents on sexual function

“…Priapism is an emergent condition. Currently, a few new techniques have been successfully developed to offer favourable outcome, such as Al‐Ghorab shunt and intracavernous tunnelling (Lian et al., ). Generally, recurrence rarely occurs after successful removal of these clots once ACAs are discontinued.…”

Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature

“…In their series, erectile function after shunt plus tunneling significantly decreased compared with that before the ischemic priapism, as the results of quality of life score, which were also significantly decreased than that before ischemic priapism. 19 More data are needed to confirm these findings.…”

“…Lian et al 19 reported disappointing results with Al-Ghorab shunt plus intracavernous tunneling for prolonged ischemic priapism in terms of erectile function. In their series, erectile function after shunt plus tunneling significantly decreased compared with that before the ischemic priapism, as the results of quality of life score, which were also significantly decreased than that before ischemic priapism.…”