(160) Prospective Evaluation of Proximal Decompression for the Management of Refractory Ischemic Priapism
Authors: Elkholy M , Zahran A , Yafi F 
Published: March 2024

Abstract

Introduction
A prolonged undesired erection of the penis that is often unrelated to sexual arousal is referred to as priapism. Over 95% of people who experience priapism are ischemic, which causes blood to become stuck in the corpora, increase hypoxia, hypercarbia, and acidosis that resemble compartment syndrome, and hinders penile venous outflow. IP is a urological emergency due to the risk of cavernosal fibrosis and consequent permanent ED. Injections of α-agonist and corporal irrigation/aspiration are the main forms of treatment for short-duration priapism, with distal shunting as a last resort. Patients with refractory and/or prolonged ischemic priapism (PIP) find their strategy more challenging. There is a low probability that irrigation/aspiration procedures, α-agonist injections, and distal shunting will work for people who have priapism that lasts longer than 24 hours.

Objective
This study was conducted on 21 male patients with refractory and\or prolonged IP to evaluate the outcomes of proximal decompression in the management of those patients. The primary end point was to assess priapism resolution in the patients. While the secondary end point was to assess erection recovery in those patients and their ability to perform sexual intercourse.

Methods
Patients’ information had been collected from the hospital data and connection with them had been through phone calls and hospital follow-up visits.

Results
Among the current study patients, the most detected etiology was tramadol intake (23.8%), followed by THC addiction and idiopathic ischemic priapism, while the least common were papaverine injection and hematological disorder (4.8%). 23.8% of the patients had twice aspirations, while 33.3% had a once. 14.3% of the patients had T shunt. 33.3% had bilateral PSD, and the other 66.7% had unilateral PSD. In the present study the decompression was successful in all the patients, where all the patients showed resolution of priapism, however 57.1% were able to perform sexual intercourse. The mean duration to achieve complete detumescence after surgery in this study was 24.2 ± 8.4 days. 33.3% had no complications, 52.4% had edema, while 14.3% had wound infection. The mean baseline IIEF score of the present study patients was 22.6 ± 2.2 (most of the patients (75%) hadn’t erectile dysfunction, 9.5% had mild erectile dysfunction and 4.8% had mild to ED), which was decreased after 3 months of the surgery (7.7 ± 2.8). Three months post-operatively severe ED was detected in 52.4% of the patients, 33.3% had moderate ED and 14.3% had mild to moderate ED. Six months after surgery the erectile dysfunction improved, where the mean IIEF score was 12.2 ± 5.0. Mild ED was detected in 23.8 %, Mild to moderate ED in 33.3 %, Moderate ED in 19 % and Severe ED in 23.8 %. The difference between the IIEF scores at base line, 3 months postoperatively and 6 months postoperatively was statistically significant.

Conclusions
Penoscrotal decompression (PSD) is a simple, safe, highly effective, and easily reproducible procedure for resolution of RIP with glans preservation in addition to more satisfactory erectile function outcomes to a certain extent

Disclosure
Yes, this is sponsored by industry/sponsor: alexandria main university hospital
Clarification: Industry funding only - investigator initiated and executed study
Any of the authors act as a consultant, employee or shareholder of an industry for: alexandria main university hospital.