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 ischemic priapism: does penoscrotal decompression outperform corporoglanular tunneling?

International Journal of Impotence Research volume 36, pages 295–296 (2024)Cite this article

Subjects

Appropriate treatment for ischemic priapism is not only time-sensitive, but equally challenging in prolonged presentation. In this article, VanDyke et. al. performed a survey of sexual medicine and genitourinary reconstructive urologists to gauge expert opinions on whether penoscrotal decompression (PSD) outperforms corporoglanular tunneling (CGT) in the setting of prolonged ischemic priapism (PIP). The study authors define PIP as starting 24 h after onset of ischemic priapism [1]. Bennett and Mulhall showed that all of patients who undergo successful decompression within 12 h from onset recover complete erectile function but this decreases to 78% between 12 and 24 h, and to 44% between 24 and 36 h from onset. Beyond 36 h, erectile dysfunction could be inevitable due to the accumulation of fibrosis of cavernosal smooth muscle [2]. Several advocates are proposing clearer practice guidelines for treatment of PIP with the ultimate objective to salvaging erectile function in PIP.

Non-invasive interventions for acute ischemic priapism, including aspiration of the corpora and intracavernosal injections of alpha-adrenergic medications, are insufficient for treating PIP [3]. More traditionally surgical interventions, including distal and proximal corporal shunts are often performed, but these have also been shown to be ineffective in the treatment of PIP, especially in patients who have experienced recurrent priapism [3]. Tunneling maneuvers, namely CGT and PSD are more effective at resolving PIP and reducing recurrent priapism. CGT was introduced in 2009 as a surgical modification on the Al-Ghorab distal shunt and showed promising results in achieving decompression [4]. PSD is a new method outlined by Fuchs et al. in 2018 that capitalizes on the well-established technique used to insert a malleable penile prosthetic that dilates the corpora with a penoscrotal approach [5]. It also avoids disruption of the distal corpora which is helpful in case penile prosthesis would need to be placed eventually to treat resultant medically-refactorry erectile dysfunction [5].

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

References

  1. 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. 2024;36:62–7. https://doi.org/10.1038/s41443-023-00808-z

    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. Levey HR, Segal RL, Bivalacqua TJ. Management of priapism: an update for clinicians. Ther Adv Urol. 2014;6:230–44. https://doi.org/10.1177/1756287214542096

    Article  PubMed  PubMed Central  Google Scholar 

  4. Burnett AL, Pierorazio PM. Corporal “snake” maneuver: corporoglanular shunt surgical modification for ischemic priapism. J Sex Med. 2009;6:1171–6. https://doi.org/10.1111/j.1743-6109.2008.01176.x

    Article  PubMed  Google Scholar 

  5. 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.

    Article  PubMed  Google Scholar 

  6. Roghmann F, Becker A, Sammon JD, Ouerghi M, Sun M, Sukumar S, et al. Incidence of priapism in emergency departments in the United States. J Urol. 2013;190:1275–80. https://doi.org/10.1016/j.juro.2013.03.118

    Article  PubMed  Google Scholar 

  7. Idris IM, Burnett AL, DeBaun MR. Epidemiology and treatment of priapism in sickle cell disease. Hematol Am Soc Hematol Educ Program. 2022;2022:450–8. https://doi.org/10.1182/hematology.2022000380

    Article  Google Scholar 

  8. 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 

Download references

Author information

Authors and Affiliations

  1. The University of Chicago, Department of Surgery, Section of Urology, Chicago, IL, USA

    Omer A. Raheem & Marwan Alkassis

  2. Pritzker School of Medicine, The University of Chicago, Chicago, IL, USA

    Rosemary Iwuala

Authors
  1. Omer A. Raheem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marwan Alkassis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosemary Iwuala
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Omer A Raheem (OAR) and Marwan Alkassis (MA) contributed with manuscript contextual structure, writing and editing. Rosemary Iwuala (RI) contributed with manuscript writing and finalizing.

Corresponding author

Correspondence to Omer A. Raheem.

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

Raheem, O.A., Alkassis, M. & Iwuala, R. Comment on: current opinions on the management of prolonged ischemic priapism: does penoscrotal decompression outperform corporoglanular tunneling?. Int J Impot Res 36, 295–296 (2024). https://doi.org/10.1038/s41443-024-00876-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41443-024-00876-9

Search

Advanced search

Quick links