Management of refractory ischemic priapism: current perspectives

Area of Science:

• Urology
• Andrology
• Sexual Medicine

Background:

• Priapism, a persistent erection, requires prompt management to prevent complications.
• Refractory ischemic priapism (IP) poses significant challenges in diagnosis and treatment.
• Penile fibrosis and erectile dysfunction are common sequelae of delayed or ineffective priapism treatment.

Purpose of the Study:

• To review the current literature on priapism diagnosis and treatment.
• To focus on state-of-the-art knowledge for refractory ischemic priapism (IP).
• To evaluate treatment options and outcomes for refractory IP.

Main Methods:

• Comprehensive literature search using PubMed and EMBASE.
• Inclusion of studies on priapism, refractory priapism, penile prosthesis, diagnosis, treatment, and fibrosis.
• Careful examination and selection of relevant studies by the authors.

Main Results:

• First-line treatments include ejaculation, exercise, cold showers, aspiration, and alpha-agonist injections.
• Distal or proximal shunts are considered if initial treatments fail.
• Penile prosthesis implantation is the definitive option for prolonged or refractory cases, addressing both priapism and erectile dysfunction.

Conclusions:

• Effective management of IP aims for detumescence and preservation of erectile function.
• Preventing penile fibrosis and shortening is crucial.
• Early penile prosthesis implantation is the gold standard for refractory IP, resolving the condition and preventing penile shortening.