Favourable multi‐institutional experience with penoscrotal decompression for prolonged ischaemic priapism

Abstract

To report our multi-institutional experience using penoscrotal decompression (PSD) for the surgical treatment of prolonged ischaemic priapism (PIP). Materials and Methods We retrospectively reviewed clinical records for patients with PIP treated with PSD between 2017 and 2020. Priapisms were confirmed as ischaemic based on clinical presentations and cavernosal blood gas abnormalities. Treatment with irrigation and injection of a-agonists in all patients had failed prior to PSD. Patient characteristics, peri-operative variables and outcomes, and changes in International Index of Erectile Function (IIEF) scores were evaluated. Results We analysed 25 patients who underwent a total of 27 PSD procedures. The mean duration of priapism at initial presentation was 71.0 h. Irrigations and injections in all patients had failed, while corporoglanular shunt treatment in 48.0% of patients (12/25) had also failed prior to PSD. Of the 10 patients who underwent unilateral PSD, two (20.0%) had priapism recurrence. Both were treated with bilateral PSD, with prompt and lasting detumescence. Among the 15 patients undergoing primary bilateral PSD, none had priapism recurrence. Of the 15 patients with documented sexual function status at last follow-up, nine (60%) reported spontaneous erectile function adequate for penetration, while six (40%) reported erectile dysfunction. The median (interquartile range) decrease in IIEF-5 score was 3.5 (0-6.75) points after PSD. Two patients underwent uneventful inflatable penile prosthesis placement following PSD. Conclusions Penoscrotal decompression presents a simple, safe, highly effective and easily reproducible procedure for resolution of PIP. PSD should be considered as a viable salvage or alternative strategy to corporoglanular shunt procedures.

Recent advances in understanding and treating priapism

“…Subsequently, nine (60%) reported spontaneous erectile function adequate for penetration, and six (40%) reported erectile dysfunction. The study established that PSD is a simple, safe, and highly effective treatment for refractory ischaemic priapism; however, further larger prospective studies and randomised controlled trials are required to confirm these findings 23 .…”

“…This glans-sparing corporal decompression technique aims to allow spontaneous recovery of erectile function and therefore reduce the need for implantation of a penile prosthesis 22 . A recent retrospective multicentre study reported on 10 patients undergoing unilateral PSD, of whom two (20%) had a recurrence of priapism 23 . A further 15 patients underwent primary bilateral PSD; none had priapism recurrence.…”

Melanotan Tanning Injection: A Rare Cause of Priapism

“…We favor PSD over distal shunts based on our experience and early multi-institutional data showing its safety, efficacy, and promising outcomes. 5 Interestingly, the patient had tolerated the same dose for 6 years in a row without experiencing priapism or any other adverse effect.…”

“…Recent data on penoscrotal decompression (PSD) has shown promising outcomes as a viable salvage or alternative strategy for management of refractory ischemic priapism and has become our preferred technique. 5 We report a priapism case presenting with a unique etiology, with an unelucidated mechanism of action. Our aim is to promote education to both patients and clinicians regarding this rare side effect of melanotan II (MT II), as well as integrate MC analogs into the risk assessment of use of drugs that may precipitate priapism.…”

Managing prolonged ischaemic priapism

“…In this issue of the BJUI , Morey et al [5] describe their multi‐institutional experience of treating ischaemic priapism by Penoscrotal decompression (PSD). The advantages of the PSD technique is that it involves a larger decompression to allow a thorough washout of the cavernosa, and it avoids breaching the distal tunica and therefore reducing potential penile prostheses complications in the future if needed.…”