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

Area of Science:

• Urology
• Andrology
• Surgical Innovation

Background:

• Prolonged ischemic priapism (PIP) is a medical emergency requiring prompt intervention.
• Standard treatments like irrigation and alpha-agonist injections often fail in severe PIP cases.
• Previous surgical options, such as corporoglanular shunts, have variable success rates.

Purpose of the Study:

• To evaluate the efficacy and safety of penoscrotal decompression (PSD) for treating prolonged ischemic priapism (PIP).
• To compare outcomes of unilateral versus bilateral PSD.
• To assess the impact of PSD on subsequent erectile function.

Main Methods:

• Retrospective review of 25 patients with PIP treated with PSD between 2017 and 2020.
• Confirmation of ischemic priapism via clinical presentation and cavernosal blood gas analysis.
• Analysis of patient demographics, peri-operative variables, recurrence rates, and International Index of Erectile Function (IIEF) scores.

Main Results:

• 27 PSD procedures were performed on 25 patients, with a mean priapism duration of 71 hours.
• PSD resolved priapism in all cases, with no recurrence after primary bilateral PSD (n=15).
• 60% of patients maintained adequate erectile function post-procedure, with a median IIEF-5 score decrease of 3.5 points.

Conclusions:

• Penoscrotal decompression (PSD) is a simple, safe, and highly effective treatment for prolonged ischemic priapism (PIP).
• PSD demonstrates a low recurrence rate, particularly when performed bilaterally.
• It represents a valuable salvage or alternative surgical strategy to corporoglanular shunts for PIP management.