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Asian Journal of Andrology (2013) 15, 75β78; doi:10.1038/aja.2012.63; published online 27 August 2012
Unsatisfactory outcomes of prolonged ischemic priapism without early surgical shunts: our clinical experience and a review of the literature
Da-Chao Zheng*, Hai-Jun Yao*, Ke Zhang, Ming-Xi Xu, Qi Chen, Yan-Bo Chen, Zhi-Kang Cai, Mu-Jun Lu and Zhong Wang
Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
Correspondence: Dr Z Wang, (zhongwang2001@yahoo.com); Dr MJ Lu, (lumujun@163.com)
* These authors contributed equally to this study.
Received 27 February 2012; Revised 17 April 2012; Accepted 22 May 2012
Advance online publication 27 August 2012
| Abstract |
Ischemic priapism is a rare occurrence which can cause severe erectile dysfunction (ED) without timely treatment. This retrospective study reports our experience in treating prolonged ischemic priapism and proposes our further considerations. In this paper, a total of nine patients with prolonged ischemic priapism underwent one to three types of surgical shunts, including nine Winter shunts, two Al-Ghorab shunts and one Grayhack shunt. During the follow-up visit (after a mean of 21.11 months), all patients' postoperative characters were recorded, except one patient lost for death. Six postoperative patients accepted a 25-mg oral administration of sildenafil citrate. The erectile function of the patients was evaluated by their postoperative 5-item version of International Index of Erectile Function Questionnaire (IIEF-5), which were later compared with their premorbid scores. All patients had complete resolutions, and none relapsed. The resolution rate was 100%. Seven patients were resolved with Winter shunts, one with an Al-Ghorab shunt and one with a Grayhack shunt. The mean hospital stay was 8.22 days. There was only one urethral fistula, and the incidence of postoperative ED was 66.67%. Four patients with more than a 72-h duration of priapism had no response to the long-term phosphodiesterase type 5 (PDE-5) inhibitor treatment. These results suggest that surgical shunts are an efficient approach to make the penis flaccid after prolonged priapism. However, the severe ED caused by prolonged duration is irreversible, and long-term PDE-5 inhibitor treatments are ineffective. Thus, we recommend early penile prosthesis surgeries for these patients.
Keywords: erectile dysfunction; PDE-5 inhibitor; penile prosthesis surgery; prolonged ischemic priapism; surgical shunts |
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