Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation

To compare the long-term results of early and delayed insertion of a penile prosthesis (PP) in men with refractory ischaemic priapism (IP).

Early insertion of a PP was carried out in 68 men with IP within a median of 7 days from the onset of priapism, while 27 had delayed insertion after a median of 5 months. The results for sexual ability, satisfaction and subjective penile shortening were assessed by questioning at follow-up visits.

In the early group, a malleable and an inflatable PP were implanted in 64 and four patients, respectively. After a median follow-up of 17 months, six patients needed revision surgery due to infection and curvature. Patient's satisfaction rate and ability to have sexual intercourse was 96%. In the delayed group, a malleable PP was inserted in 12 patients and an inflatable in the remaining 15. In all, 80% of the patients required a second corporotomy and downsized cylinders due to dense fibrosis. After a median follow-up of 21 months,seven patients required revision surgery due to infection,erosion and mechanical failure. In all, 25 patients were able to engage in sexual intercourse but the satisfaction rate was only 60% mainly due to significant penile shortening.

Early PP implantation should be the preferred option inpatients with IP, as the procedure is technically easier, has less complication rates and allows greater preservation of penile length.