Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Comment
  • Published:

Comment on: “Current opinions on the management of prolonged ischaemic priapism: does penoscrotal decompression outperform corporoglanular tunneling?”

International Journal of Impotence Research volume 36, pages 94–95 (2024)Cite this article

Subjects

There is broad consensus that ischaemic priapism requires prompt emergent treatment. Delays in decompression will result in erectile dysfunction (ED) with the associated risks of penile shortening and fibrosis. Erectile function is closely associated with the duration of ischaemia [1]. Bennett and Mulhall showed that if ischaemic priapism is reversed within 12 h from onset, 100% of patients recover their erectile function but this decreases to 78% between 12 and 24 h, and to 44% between 24 and 36 h from onset. ED is almost invariable after 36 h from onset [2].

Options for decompression have not changed significantly over the last decade. First line treatment for ischaemic priapism is aspiration of the corpora (with or without irrigation) and intracavernosal injection of alpha-adrenergic medications (preferably phenylephrine) [3]. If this fails, patients usually proceed to have a distal corporal shunt and where there is recurrence or persistence of the priapism, a tunneling manoeuvre can be considered. A penile prosthesis can be inserted where the priapism duration prior to presentation is long (despite treatment) and resultant ED likely.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Data availability

This article does not include any data elaboration.

References

  1. Zacharakis E, Raheem AA, Freeman A, Skolarikos A, Garaffa G, Christopher AN, et al. The efficacy of the T-shunt procedure and intracavernous tunneling (snake maneuver) for refractory ischemic priapism. J Urol. 2014;191:164–8. https://doi.org/10.1016/j.juro.2013.07.034.

    Article  PubMed  Google Scholar 

  2. Bennett N, Mulhall J. Sickle cell disease status and outcomes of African-American men presenting with priapism. J Sex Med. 2008;5:1244–50. https://doi.org/10.1111/j.1743-6109.2008.00770.x.

    Article  PubMed  Google Scholar 

  3. Bivalacqua TJ, Allen BK, Brock G, Broderick GA, Kohler TS, Mulhall JP, et al. Acute ischemic priapism: an AUA/SMSNA guideline. J Urol. 2021;206:1114–21. https://doi.org/10.1097/JU.0000000000002236.

    Article  PubMed  Google Scholar 

  4. Fuchs JS, Shakir N, McKibben MJ, Mathur S, Teeple S, Scott JM, et al. Penoscrotal decompression-promising new treatment paradigm for refractory ischemic priapism. J Sex Med. 2018;15:797–802. https://doi.org/10.1016/j.jsxm.2018.02.010.

    Article  PubMed  Google Scholar 

  5. Baumgarten AS, VanDyke ME, Yi YA, Keith CG, Fuchs JS, Ortiz NM, et al. Favourable multi-institutional experience with penoscrotal decompression for prolonged ischaemic priapism. BJU Int. 2020;126:441–6. https://doi.org/10.1111/bju.15127.

    Article  CAS  PubMed  Google Scholar 

  6. Salonia A, Bettocchi C, Capogrosso P, Carvalho, Corona G, Hatzichristodoulou G, et al. EAU guidelines on sexual and reproductive health. Arnhem, The Netherlands: EAU Guidelines Office; 2022

  7. VanDyke ME, Smith WJ, Holland LC, Langford BT, Joshi EG, Dropkin BM, et al. Current opinions on the management of prolonged ischemic priapism: does penoscrotal decompression outperform corporoglanular tunneling? Int J Impot Res. 2023:1–6. https://doi.org/10.1038/s41443-023-00808-z.

  8. Lee WG, Wardak S, Ralph D. Penoscrotal decompression: a new paradigm for managing prolonged ischemic priapism. J Sex Med. 2023;20:i145. https://doi.org/10.1093/jsxmed/qdad060.229.

    Article  Google Scholar 

  9. Sedigh O, Rolle L, Negro CLA, Ceruti C, Timpano M, Galletto E, et al. Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature. Int J Impot Res. 2011;23:158–64. https://doi.org/10.1038/ijir.2011.23.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University College London Hospitals, London, W1G 8PH, UK

    Wai Gin Lee, Andrea Gobbo & David Ralph

  2. St Peter’s Andrology, 54 Beaumont Street, London, W1G 6AA, UK

    Wai Gin Lee & David Ralph

  3. Department of Biomedical Science, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy

    Andrea Gobbo

Authors
  1. Wai Gin Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Gobbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Ralph
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed significantly to the development of the manuscript and meet the criteria for authorship. They have actively participated in the research process, provided intellectual input, and critically reviewed the content. Each author has approved the final version of the manuscript.

Corresponding author

Correspondence to David Ralph.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, W.G., Gobbo, A. & Ralph, D. Comment on: “Current opinions on the management of prolonged ischaemic priapism: does penoscrotal decompression outperform corporoglanular tunneling?”. Int J Impot Res 36, 94–95 (2024). https://doi.org/10.1038/s41443-024-00826-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-024-00826-5

This article is cited by

Search

Advanced search

Quick links