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Updated: Jul 8, 2025

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Caverno-saphenous shunt for recurrent priapism.

Jade Nguyen1, Sherwin Abdoli1, Christian Ochoa2

  • 1Department of Vascular Surgery, Huntington Hospital, Pasadena, CA.

Journal of Vascular Surgery Cases and Innovative Techniques
|December 18, 2023
PubMed
Summary

This case study details a rare instance of priapism caused by medication misuse, ultimately requiring a complex surgical bypass. The caverno-saphenous bypass successfully restored partial sexual function after conventional treatments failed.

Keywords:
Caverno-saphenous shuntRecurrent priapism

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Area of Science:

  • Urology
  • Pharmacology
  • Surgical Innovation

Background:

  • Medication-induced priapism, particularly from injectable erectile dysfunction treatments like Trimix (alprostadil, papaverine, phentolamine), presents a significant clinical challenge.
  • Recurrent priapism episodes can lead to treatment refractory states, necessitating advanced therapeutic strategies beyond standard urological algorithms.
  • The misuse of erectile dysfunction medications can result in severe, persistent priapism, impacting patient health and requiring specialized interventions.

Observation:

  • A patient with a history of medication misuse developed priapism refractory to conventional treatments including phenylephrine, aspiration, and distal shunting.
  • Despite initial successful management, continued misuse of injectable erectile dysfunction medication led to treatment failure.
  • The refractory nature of the priapism necessitated a rare surgical intervention: a proximal caverno-saphenous bypass.

Findings:

  • The caverno-saphenous bypass procedure was successfully performed as a treatment for refractory priapism.
  • Following the surgical intervention, the patient experienced preservation of partial sexual function.
  • The bypass graft remained patent post-operatively, indicating a successful surgical outcome.

Implications:

  • This case highlights the potential for severe priapism due to erectile dysfunction medication misuse.
  • Extra-anatomic bypass surgery, such as the caverno-saphenous bypass, represents a viable, albeit rare, option for refractory priapism.
  • Effective management strategies for priapism require careful consideration of medication misuse and the potential need for advanced surgical techniques.