Changing Surgical Concepts in the Treatment of Priapism

Abstract

The treatment of priapism has changed significantly because of better understanding of the physiology of erection and of the pathophysiology of the disease. Several operative procedures have been advised to provide better venous drainage to the corpora. Herein we describe our experience with 20 patients. In 7 cases a modification of the cavernospongiosum shunt was used. This shunt is done under direct vision at the level of the proximal glans, thus, providing a better cavernosum-spongiosum shunt.

Priapism

“…This can be performed in a variety of methods as shown in Table 2. Winter shunt (caverno-glanular shunt) 47 Percutaneous shunt with tru-cut needle from glans to tip of corpus cavernosum Al-Ghorab (caverno-glanular shunt) 48 Formal incision at corona and removal of corporal tips b communication between glans and corpora Quakles (caverno-spongiosal shunt) 49 Formal surgical anastomosis of corpus cavernosum with proximal corpus spongiosum Grayhack (caverno-saphenous shunt) 50 Anastomosis of corpus cavernosum with saphenous vein Caverno-penile dorsal vein shunt 51 Anastomosis of corpus cavernosum with dorsal vein …”

Priapism in Sickle Cell Disease: The Case for Early Implantation of the Penile Prosthesis

“…The mainstay emergency room management of sicklecell-associated priapism incorporates analgesia, hydra tion, alkalization, oxygenation, and hypertransfusion of packed red blood cells [6], Rapid transfusion dilutes the percentage of sickle hemoglobin in circulation and sup presses the bone marrow release of additional abnormal red cells, thereby increasing oxygen delivery to the corpo ra [10], Additional conservative measures that have been reported in the literature include ice packs, hot soaks, ene mas, transrectal diathermy, estrogens, hyperbaric oxygen, radiation, anticoagulation, fibrinolytic therapy, vasodila tors, antimuscarinics, anxiolytics, spinal anesthesia with hypotension, and erythrocytophoresis [2,3,11], Partial exchange transfusion to reduce hemoglobin S to 30% or less has been recommended when ischemic priapism per sists beyond 24 h [12], Partial exchange transfusion may be associated with severe neurologic complications, possi bly due to changes in blood viscosity and cerebral blood flow or coexisting coagulation abnormalities aggravated by release of reperfusion metabolites from the corpora [9], Conservative measures are most effective in the pediatric population [2], When these measures fail, invasive management may include aspiration and saline irrigation of the corpora (with or without adrenergic drugs) and shunt procedures from the corpus cavemosum to the glans penis, corpus spongiosum or saphenous vein [13], Unfortunately, sickle cell priapism is prone to recurrence following these proce dures [2], Success with hormonal manipulation to prevent recurrent episodes of priapism in sickle cell patients using diethylstilbestrol and gonadotropin-releasing hormone analogues (leuprolide and goserelin acetates) has been reported recently [14,15]. Success with diethylstilbestrol was achieved in 9 of 11 patients, but priapism recurred in several.…”

Urethrocutaneous fistula as a severe complication of treatment for priapism

“…Drainage and irrigation of the corpora followed by an injection with 50 mg phenylephrine usually causes detumescence in most cases. In prolonged priapism a shunt procedure [1,2] may be indicated. If the erection persists for >48 h, permanent damage to the penile microvascular system may change veno-occlusive priapism into the high-¯ow type [3]; superselective embolization using absorbable emboli may then be the best way to obtain detumescence.…”