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Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism: a systematic review by the EAU Sexual and Reproductive Health Guidelines panel

International Journal of Impotence Research volume 36, pages 36–49 (2024)Cite this article

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Abstract

Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an arterial fistula and embolisation may be required. We conducted a systematic review on behalf of the EAU Sexual and Reproductive health Guidelines panel to analyse the available evidence on efficacy and safety of surgical modalities for IP and NIP. Outcomes were priapism resolution, sexual function and adverse events following surgery. Overall, 63 studies (n = 923) met inclusion criteria up to September 2021. For IP (n = 702), surgery comprised distal (n = 274), proximal shunts (n = 209) and penile prostheses (n = 194). Resolution occurred in 18.7-100% for distal, 5.7–100% for proximal shunts and 100% for penile prostheses. Potency rate was 20–100% for distal, 11.1–77.2% for proximal shunts, and 26.3–100% for penile prostheses, respectively. Patient satisfaction was 60–100% following penile prostheses implantation. Complications were 0–42.5% for shunts and 0–13.6% for IPP. For NIP (n = 221), embolisation success was 85.7–100% and potency 80–100%. The majority of studies were retrospective cohort studies. Risk of bias was high. Overall, surgical shunts have acceptable success rates in IP. Proximal/venous shunts should be abandoned due to morbidity/ED rates. In IP > 48 h, best outcomes are seen with penile prostheses implantation. Embolisation is the mainstay technique for NIP with high resolution rates and adequate erectile function.

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Author notes

  1. These authors contributed equally: S. Minhas, A. Salonia.

Authors and Affiliations

  1. Department of Urology, University Hospitals Leuven, Leuven, Belgium

    U. Milenkovic

  2. Department of Urology, University of Florence, Florence, Italy

    A. Cocci

  3. Department of Urology, Newcastle University, Newcastle, UK

    R. Veeratterapillay

  4. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK

    K. Dimitropoulos

  5. Department of Urology, IRCCCS Granda Ospedale Maggiore Policlinico, Milan, Italy

    L. Boeri

  6. ASST-Sette Laghi, Circolo & Fondazione Macchi Hospital, University of Insurbria, Varese, Italy

    P. Capogrosso

  7. Department. of Urology, Istanbul Taksim GOP Training and Research Hospital, Istanbul, Turkey

    N. C. Cilesiz

  8. Department of Reproductive Biology, Copenhagen University Hospital, Copenhagen, Denmark

    M. Gul

  9. Department of Urology, Krankenhaus Martha-Maria Nürnberg, Nurnberg, Germany

    G. Hatzichristodoulou

  10. Department of Urology, Manchester Royal Infirmary, Manchester, UK

    V. Modgil

  11. Department of Urology, University of Catania, Catania, Italy

    G. I. Russo

  12. Department of Urology, Charing Cross Hospital, London, UK

    T. Tharakan

  13. Department of Urology, University of Aberdeen, Abderdeen, UK

    M. I. Omar

  14. Department of Urology, University of Foggia, Foggia, Italy

    C. Bettocchi

  15. Department of Psychology and Health Sciences, Universidade Lusofona de Humanidades e Tecnologias, Lisbon, Portugal

    J. Carvalho

  16. Department of Medicine, McMaster University, Hamilton, Canada

    Y. Yuhong

  17. Department of Endocrinology, Maggiore-Bellaria Hospital, Bologna, Italy

    G. Corona

  18. Department of Endocrinology, Barnsley Hospital, Barnsley, UK

    H. Jones

  19. Department of Radiology, Istanbul Faculty of Medicine, Istanbul, Turkey

    A. Kadioglu

  20. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain

    J. I. Martinez-Salamanca

  21. Department of Urology, University Federico II of Naples, Naples, Italy

    P. Verze

  22. Department of Urology, Bahceci Health Group, Istanbul, Turkey

    E. C. Serefoglu

  23. Department of Urology, Imperial College, London, UK

    S. Minhas

  24. Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy

    A. Salonia

  25. University Vita-Salute San Raffaele, Milan, Italy

    A. Salonia

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  1. U. Milenkovic
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Contributions

Concept and design: UM, AC, RV, KD, LB, PC, NC, MG, GH, VM, GIR, TT, MIO, CB, JC, YY, GC, HJ, AK, JIMS, PV, ECS, SM, AS; Acquisition of data: UM, AC, RV, KD; Analysis and interpretation of data, UM, AC, RV, KD, SM, AS; Drafting of the manuscript: UM, AC, RV, KD, LB, PC, NC, MG, GH, VM, GIR, TT, MIO, CB, JC, YY, GC, HJ, AK, JIMS, PV, ECS, SM, AS; Critical revision of the manuscript for important intellectual content: UM, AC, RV, KD, LB, PC, NC, MG, GH, VM, GIR, TT, MIO, CB, JC, YY, GC, HJ, AK, JIMS, PV, ECS, SM, AS; Statistical analysis: UM; Obtaining funding: NA; Administrative, technical or material support: YY, ECS, SM, AS; Supervision: MIO, CB, JC, YY, GC, HJ, AK, JIMS, PV, ECS, SM, AS.

Corresponding author

Correspondence to A. Salonia.

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Milenkovic, U., Cocci, A., Veeratterapillay, R. et al. Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism: a systematic review by the EAU Sexual and Reproductive Health Guidelines panel. Int J Impot Res 36, 36–49 (2024). https://doi.org/10.1038/s41443-022-00604-1

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