[Priapism; a surgical emergency]

Only emergency surgery performed within the first 36 hours can reduce priapism, which leads inevitably to impotence if unoperated. In a case of priapism, the venous return of the corpora cavernosa is prevented and so it is necessary to deflect the blood contained in the corpus cavernosum either towards the long saphenous vein, or towards the corpora spongiosa: in a case of priapism, only the corpora cavernosa are involved in irreducible erection. The two best procedures are the formation of a bilateral passage between the long saphenous vein, brought into a subcutaneous canal, with the corpora cavernosa at the base of the penis, and the inosculation of the corpora cavernosa and spongiosa, level with the perineum, just before the bulb. The shunt between the corpora cavernosa and spongiosa may ultimately be achieved quite simply by using bistoury to open a passage between the corpus cavernosum and the gland which is itself an extension of the corpora spongiosa. Cavernous radiography will register the quality of the venous return, and any resultant cavernous residual sclerosis, which is one cause of failure.