The Immediate Insertion of a Penile Prosthesis for Acute Ischaemic Priapism

Background: Ischaemic priapism (IP), which is refractory to conventional medical and surgical intervention, results in necrosis of the corpus cavernosum smooth muscle. These patients eventually develop a variable degree of corporal smooth muscle fibrosis that presents as erectile dysfunction and penile shortening. Objectives: To evaluate the long-term outcome of patients who have undergone the immediate insertion of a penile prosthesis as a treatment for an acute episode of IP refractory to medical therapy or shunt surgery. Design, setting, and participants: A total of 50 patients presented with prolonged IP that was unresponsive to conventional treatment. Unsuccessful shunt surgery had been performed in 13 patients. All patients had evidence of cavernosal smooth muscle necrosis and, therefore, underwent an immediate insertion of a penile prosthesis in the acute setting. Measurements: Mean age, duration of priapism in hours, intraoperative and postoperative complications, the surgical outcome, and patients' satisfaction were recorded. Results and limitations: A malleable penile prosthesis was inserted in 43 patients and a three-piece inflatable implant in was inserted in 7 patients; a subsequent elective exchange of a malleable to an inflatable device was performed in 6 patients. After a median follow-up of 15.7 mo (4-60 mo), 42 patients had already resumed successful sexual intercourse. Prosthesis infection occurred in three patients (6%), which was managed by explantation and delayed reinsertion. A further six patients needed revision surgery. No patient complained of penile shortening, and the overall satisfaction rate was 96%. Conclusions: The immediate insertion of a penile prosthesis for acute refractory ischaemic priapism is a simple and successful procedure that treats the acute episode as well as the inevitable erectile dysfunction that will occur with preservation of penile length. (C) 2008 European Association of Urology. Published by Elsevier B. V. All rights reserved.