Early penile prosthesis implantation in refractory ischaemic priapism: a narrative review

Ischaemic priapism (IP) is a urological emergency that can lead to permanent erectile dysfunction (ED) and penile deformity if not promptly managed. Refractory ischaemic priapism (RIP), defined as IP persisting beyond 48 hours despite conventional interventions, necessitates a paradigm shift in treatment strategy. Early penile prosthesis (PP) implantation offers a proactive approach in surgical management to preserve penile function while minimising complications associated with delayed surgery. This review synthesises current evidence on early PP insertion for RIP, evaluating its advantages over delayed intervention. We examine the pathophysiological progression of IP, emphasising corporal smooth muscle necrosis and penile fibrosis, which render erectile function recovery unlikely even with successful detumescence. Limitations of shunting procedures are also discussed and emerging diagnostic tools highlighted, such as magnetic resonance imaging (MRI), for assessing irreversible corporal damage. Comparative analysis of early versus delayed PP insertion reveals superior patient satisfaction, lower revision rates, reduced penile shortening, and fewer perioperative complications with early implantation. Device selection, operative techniques, and risk mitigation strategies are also explored. Our findings support early PP implantation as the preferred management strategy for RIP, aligning with international guidelines. Further research is warranted to refine surgical protocols and optimise patient outcomes.