PURPOSE: The current management of ischemic priapism that is refractory to conventional medical therapy is a form of shunt procedure that diverts blood away from the corpus cavernosum.
We assessed the outcome of the T-shunt and intracavernous tunneling for the management of ischemic priapism.
MATERIALS AND METHODS: During a 36-month period 45 patients presented with prolonged ischemic priapism. Patients were divided into subgroups according to the duration of priapism. All patients had an unsuccessful primary treatment, and underwent a T-shunt and intracavernous tunneling with cavernous muscle biopsies. All patients completed an International Index of Erectile Function (IIEF)-5 questionnaire preoperatively and 6 months postoperatively.
RESULTS: Resolution of the priapism using a T-shunt and snake maneuver occurred in all patients with a priapism duration of less than 24 hours and in only 30% of those with priapism lasting more than 48 hours. After a 6-month median followup the IIEF-5 score was significantly reduced from a mean of 24 (range 23 to 25) preoperatively to 7.7 (range 5 to 24), which was related to the duration of the priapism (p < 0.0005). All patients with priapism for more than 48 hours had necrotic cavernous smooth muscle on biopsy and had severe erectile dysfunction requiring the insertion of a penile prosthesis. Those patients with moderate and mild erectile dysfunction were treated with phosphodiesterase type 5 inhibitors.
CONCLUSIONS: The success of the T-shunt with snake tunneling is dependent on the duration of priapism. When it is less than 24 hours the results are favorable, although erectile dysfunction is still present in 50% of patients. In those with a duration priapism greater than 48 hours the technique usually fails to resolve the priapism and all patients end up with erectile dysfunction due to smooth muscle necrosis.
Written by:
Zacharakis E, Raheem AA, Freeman A, Skolarikos A, Garaffa G, Christopher AN, Muneer A, Ralph DJ. Are you the author?
Institute of Urology, University College Hospital London, London, United Kingdom; 2nd Department of Urology, National and Kapodistrian University of Athens, Athens, Greece.
Reference: J Urol. 2013 Jul 24. pii: S0022-5347(13)04915-X.
doi: 10.1016/j.juro.2013.07.034
PubMed Abstract
PMID: 23892191
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