(011) PENOSCROTAL DECOMPRESSION IN REFRACTORY ISCHAEMIC PRIAPISM: A REVIEW AND PROPORTIONAL META-ANALYSIS OF A NOVEL TECHNIQUE WITH PROMISING RESULTS
Authors: Mubarak M , Isa Q , Hayes J , Modgil V , Pearce I 
Published: December 2024

Abstract

Introduction
Penoscrotal decompression (PSD) is a novel surgical technique first described by Fuchs et al. in 2018. It involves accessing the corporal bodies via a penoscrotal incision with proximal coroportomies and subsequent drainage of ischaemic blood leading to detumescence. Although PSD has been recently popularised, its outcomes have been considered encouraging when considering operative success, recurrence rates, and preservation of erectile function.

Objective
This review and meta-analysis aims to holistically explore all available evidence on PSD and evaluate PSD’s utility and eRicacy as a surgical approach in a) achieving detumescence, b) preventing recurrence, and c) maintaining erectile function.

Methods
This systematic review was done in concordance with the PRISMA guidelines. Nine databases were thoroughly searched with all literature available, excluding metaanalyses, reviews, guidelines, editorials, and expert opinions. There were no restrictions on time or language of publication. Data extraction and descriptive analysis were performed using Microsoft Excel. A meta-analysis of proportions and heterogeneity studies was carried out using R. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies, where applicable. A p-value of 0.05 was considered statistically significant.

Results
Of the 110 screened studies, 11 were eligible for further review. The studies include five case reports, four abstracts and two observational cohort studies, including data from 97 patients with refractory ischaemic priapism. Drug-induced priapism was the most common cause, and less than half of the patients (44.3%) had a distal shunt before PSD. PSD laterality was described in 69 patients, with 31 and 38 having unilateral and bilateral decompressions, respectively. Detumescence was achieved in 95 out of 97 participants with a pooled proportion of 91% (CI 95%: 0.84-0.95). Post-PSD recurrence occurred in a total of 12% (95% CI: 0.06-0.21). Erectile function was preserved in 51% of the patients with follow-up (95% CI: 0.39-0.62). Heterogeneity was low amongst the studies reporting the outcomes of interest. Limitations noted included: a) A small patient sample, b) Variability in decompression techniques, c) Unspecified rationale for choosing unilateral or bilateral decompression, and d) If bilateral decompression was used only after a failed unilateral decompression.

Conclusions
Early evidence suggests that PSD is a feasible and eRicacious surgical technique in RIP. It oRers high detumescence rates, with a lower risk of recurrence and a better erectile functional preservation rate in contrast to other surgical techniques. Moving forward, to further outline its long-term outcomes, we encourage prospective data collection with 1. A standardised surgical approach to decompression 2. Medium to long-term followup and 3. Exploration of alternative approaches, such as an infrapubic approach.

Disclosure
No.