Recent advances in understanding and treating priapism

Abstract

Priapism is a rare condition that can lead to long-term erectile dysfunction if left untreated. It is one of the few urological emergencies that require prompt medical intervention. Priapism refers to a penile erection that lasts for more than 4 hours and is unrelated to sexual stimulation or orgasm. The aims of immediate intervention for ischaemic priapism are to resolve the painful erection and preserve the cavernosal smooth muscle function. The aim of this review is to evaluate the latest advances in the management of priapism. Despite the continuous challenge in providing an optimal treatment for this rare urological condition, our understanding and management of it have been advanced by decades of clinical and basic science research. Proximal shunts (Quackels or Grayhack) are no longer routinely performed. Distal shunt procedures are currently the most commonly used techniques. A novel penoscrotal decompression technique has recently been described. Ischaemic priapism can be managed conservatively in most cases with the preservation of erectile function. In cases where ischaemic priapism has persisted for more than 36 hours, the majority will develop erectile dysfunction. Early penile prosthesis with thorough patient counselling should be considered in such cases. In some cases of long-standing non-ischaemic priapism, patients can develop fibrosis within the distal corpora, and, therefore, early treatment with super-selective embolisation is required to prevent this.

Successful Management of Prolonged Acute Ischemic Priapism With Penoscrotal Decompression: A Case Report and Review of the Literature

“…The first study, written by Alnajjar et al. was a narrative review in which the latest advances in the management of priapism were discussed [ 7 ]. They described the three subtypes of priapism: ischemic, nonischemic, and stuttering priapism, also known as recurrent ischemic priapism.…”

“…This procedure begins with an initial penoscrotal incision followed by corporotomy to allow drainage of blood. This technique aims to allow recovery of erectile function by sparing the glans [ 7 ].…”

“…Another set of 15 patients underwent bilateral PSD, none of whom had any recurrence of priapism, nine who had enough erectile function for penetration, and six who had ensuing erectile dysfunction [ 8 ]. This study highlighted how PSD could be a safe and effective treatment for refractory priapism [ 7 ].…”

Tissue Engineering for Penile Reconstruction

“…A novel penoscrotal decompression technique has recently been described. Early treatment with super-selective embolization can be required [ 51 ]. Surgical interventions have consisted primarily of penile revascularization surgery for arterial insufficiency and penile venous surgery for corporoveno-occlusive dysfunction, whatever the mechanism.…”

Refractory Ischemic Priapism Following Hemodialysis

“…Priapism is characterized by a prolonged and painful erection of the penis lasting beyond four hours without sexual stimulation. An overall rare condition, priapism accounts for an estimated 1.5 cases per 100,000 in men [1]. Common causes include conditions such as sickle cell disease, trauma, and certain medications [2].…”