Temporary cavernosal-cephalic vein shunt in low-flow priapism treatment

Surgical shunting might be considered as the only option in the treatment of extended ischemic priapism that does not respond to aspiration and medication.

A modified, simple, minimally invasive, and easily applicable artificial cavernosal-venous shunt technique for treating priapism is described in this report.

A total of 15 patients with extended and nonresponsive low-flow priapism were treated with this technique between January 1998 and February 2007.

When the conservative treatment of low-flow priapism does not yield the expected results, then the temporary cavernosal-cephalic vein shunt should be applied. The standard equipment required for this modified technique includes three angiocaths, two shorn blood serum sets, and saline solution with heparin. The blood in the cavernosa and the saline solution infusion are incorporated into the systemic circulation with the aid of serum sets and angiocaths.

Priapism duration, history, causes, its relation with sexual stimulation, pain, and any prior management of priapism were assessed in all patients. A complete blood count and blood gases assessment were conducted in corporal aspirates, and duplex penile ultrasonography was performed, which showed attenuated blood flow in the cavernosal artery.

This technique was applied in 15 patients. Complete detumescence was achieved in 13. In the two cases in whom the technique did not yield the expected results, there was a need for a sapheno-cavernosal shunt. These patients later complained of erectile dysfunction and penile pain that continued for 6 mo. Of the 13 patients in whom detumescence was achieved, 3 reported erectile dysfunction according to International Index of Erectile Function (IIEF) scores at the 12-mo follow-up.

Artificial cavernosal-cephalic vein shunt in the treatment of priapism is simple, safe, effective, easily applicable, and warrants primary consideration when the second-line treatment of priapism is initiated.