Penoscrotal decompression should be considered for prolonged ischaemic priapism

Area of Science:

• Urology
• Andrology
• Surgical Innovation

Background:

• Prolonged ischemic priapism (PIP) is a critical condition often leading to erectile dysfunction, particularly when lasting over 48 hours.
• Current treatment options for PIP can be limited, necessitating exploration of effective surgical interventions.

Purpose of the Study:

• To evaluate the surgical and functional outcomes of patients with PIP treated using penoscrotal decompression (PSD).
• To assess the efficacy of a modified PSD technique involving a proximal penile shaft incision.

Main Methods:

• Retrospective analysis of patients with PIP undergoing PSD between 2019 and 2024 across two tertiary centers.
• Comparison of outcomes between bilateral and unilateral PSD, and assessment of success based on timing of presentation.
• Evaluation of surgical success (pain resolution, no recurrence), perioperative results, and sexual function (IIEF-5, penile prosthesis use).

Main Results:

• PSD achieved a 69% success rate, with higher efficacy (73%) in bilateral procedures.
• Immediate detumescence (96%) and pain relief (92%) were commonly observed.
• Treatment success was time-dependent, with superior outcomes when performed within 36 hours; 86% reported satisfactory erectile function post-treatment.

Conclusions:

• Penoscrotal decompression is a safe and effective treatment for prolonged ischemic priapism.
• The modified technique with a penile shaft incision offers advantages in accessibility for urologists.
• Timeliness of intervention (within 36 hours) and bilateral approach are key factors for optimal outcomes in PSD for PIP.