The management of the acute ischemic priapism: A state of the art review.

To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism (IP).

A systematic search for the terms "penile prosthesis", "priapism", "impotence", "fibrosis", "downsized prosthesis cylinders", and "patient satisfaction" has been carried out in PubMed, EMBASE, Cochrane, SCOPUS and Science Citation Index databases.

Cavernosal tissue damage in IP is time related. Conservative measures and aspiration with or without intracorporeal instillation of α-adrenergic agonists are usually successful in the early stages. Shunt surgery in patients remains debatable, as the lack of response to aspiration and instillation of α-adrenergic agonists indicates that irreversible changes in the cavernosal smooth muscle are likely to have already occurred. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening. Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient's satisfaction following surgery.

Actas urologicas espanolas. 2017 May 18 [Epub]

M Falcone, A Gillo, M Capece, A Raheem, D Ralph, G Garaffa

St. Peter's Andrology and The Institute of Urology, University College of London Hospital (UCLH), Londres, Reino Unido; Department of Urology, University of Turin, Città della Salute e della Scienza, Turín, Italia. Electronic address: ., Department of Urology, Umberto Parini Hospital, Aosta, Italia., St. Peter's Andrology and The Institute of Urology, University College of London Hospital (UCLH), Londres, Reino Unido; Department of Urology, University of Naples, Nápoles, Italia., St. Peter's Andrology and The Institute of Urology, University College of London Hospital (UCLH), Londres, Reino Unido; Department of Andrology, University of Cairo, Cairo, Egipto., St. Peter's Andrology and The Institute of Urology, University College of London Hospital (UCLH), Londres, Reino Unido.