Penile prosthesis placement in the setting of prolonged refractory ischemic priapism: a single institution experience
Baumgarten, A1; Shah, B1; Binner, M1; Beilan, J1; Loeb, A1; Parker, J1; Carrion, R1; Slongo, J1
1: University of South Florida, United States
Objectives: Erectile dysfunction is a well-known complication of prolonged ischemic priapism. The purpose of this study is to present and analyze our institution’s experience of immediate penile prosthesis (PP) placement in the setting of prolonged ischemic priapism refractory to irrigation and/or shunting procedures.
Materials and Methods: A total of 18 patients presented with prolonged ischemic priapism unresponsive to conventional management between 2011 and 2017 at a single institution. All patients had evidence of ischemic priapism on cavernous blood gas. Each patient experienced priapism for greater than 24 hours and had failed conservative management including corporal aspiration and irrigation +/- phenylephrine. Eight patients (44.4%) underwent unsuccessful shunting procedures prior to surgery.
Results: A semi-rigid PP was placed in 16 patients and a three-piece inflatable PP was placed in 2 patients. Mean patient age was 43.9 years old (20-62 years old). 4 patients (22.2%) developed prosthetic infection, all requiring surgical intervention. Mean follow up was 4.8 months (1-36 months). At last follow up, 15 patients (83.3%) have a PP in place. All 15 patients are sexually active and satisfied with their overall result.
Conclusions: Immediate PP placement is an effective and reasonable option in men with prolonged ischemic priapisms refractory to conventional management. PP placement not only successfully treats the underlying pathology but also eliminates future erectile dysfunction and helps maintain penile length. Patients should be counselled on the increased risk of infection in this setting.
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