Presentation Authors: Yooni Yi*, Michael Davenport, Dallas, TX, Billy Cordon, Miami, FL, Jeffrey Gahan, Rachel Bergeson, Allen Morey, Dallas, TX
Introduction: Although widely practiced and broadly recommended for definitive relief of refractory ischemic priapism (RIP), corporoglanular shunts are prone to failure in refractory cases with delayed presentation. We report our updated experience using a novel midshaft penile decompression procedure as a glans sparing alternative to corporoglanular shunts for surgical treatment of RIP.
Methods: We retrospectively reviewed clinical records for RIP patients treated with penoscrotal decompression (PSD) from 2014 - 2018. Priapistic episodes were confirmed as ischemic on the basis of clinical presentation and arterial blood gas abnormalities. All patients had failed irrigations and penile injection of alpha agonist prior to PSD. Patient characteristics, duration and etiology of RIP, prior interventions, and clinical outcomes were recorded.
Results: We analyzed 13 RIP patients (mean age of 29.5 years [range 12 - 53]), of which six patients had failed a distal corporoglanular T-shunt prior to PSD and the other seven had failed irrigations and injections only; none had proximal shunts. Despite an extended time to presentation (mean 61.2 hours), all 13 RIP patients had prompt resolution of priapistic symptoms after PSD surgery. The most common priapism etiologies in the cohort were Sickle Cell Disease (4), illicit drug use (4- cocaine, valium, methamphetamine), and intracavernosal injections (3). Other etiologies were depo testosterone and idiopathic. Of the 10 patients with documented follow-up (median 51.5 days), many reported some preservation of potency status after PSD surgery (3- normal erectile function, 2- spontaneous erections, 1- no erections). One with preoperative erectile dysfunction later underwent an inflatable penile prosthesis uneventfully 251 days following PSD.
Conclusions: Penoscrotal decompression represents a simple and highly effective option for resolution of refractory ischemic priapism. In this challenging population, PSD appears to have a role both in lieu of corporoglanular shunt and as a salvage strategy for those who have failed prior corporoglanular shunts.