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Current opinions on the management of prolonged ischemic priapism: does penoscrotal decompression outperform corporoglanular tunneling?

International Journal of Impotence Research volume 36, pages 62–67 (2024)Cite this article

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Abstract

Prolonged ischemic priapism presents a treatment challenge given the difficulty in achieving detumescence and effects on sexual function. To evaluate current practice patterns, an open, web-based multi-institutional survey querying surgeons’ experience with and perceived efficacy of tunneling maneuvers (corporoglanular tunneling and penoscrotal decompression), as well as impressions of erectile recovery, was administered to members of societies specializing in male genital surgery. Following distribution, 141 responses were received. Tunneling procedures were the favored first-line surgical intervention in the prolonged setting (99/139, 71.2% tunneling vs. 14/139, 10.1% implant, p < .001). Although respondents were more likely to have performed corporoglanular tunneling than penoscrotal decompression (124/138, 89.9% vs. 86/137, 62.8%, p < .001), penoscrotal decompression was perceived as more effective among those who had performed both (47.3% Very or Extremely Effective for penoscrotal decompression vs. 18.7% for corporoglanular tunneling; p < .001). Many respondents who had performed both tunneling procedures felt that most regained meaningful sexual function after either corporoglanular tunneling or penoscrotal decompression (33/75, 44.0% vs. 33/74, 44.6%, p = .942). While further patient-centered investigation is warranted, this study suggests that penoscrotal decompression may outperform corporoglanular tunneling for prolonged priapism, and that recovery of sexual function may be higher than previously thought after tunneling procedures.

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Fig. 1: Tunneling operations for priapism.
Fig. 2
Fig. 3
Fig. 4: Impressions Regarding Recovery of Sexual Function.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Urology, University of Texas Southwestern, Dallas, TX, USA

    Maia E. VanDyke, Wesley J. Smith, Levi C. Holland, Brian T. Langford, Eshan G. Joshi, Bryce P. Franzen, Steven J. Hudak & Allen F. Morey

  2. Department of Urology, University of Kentucky, Lexington, KY, USA

    Benjamin M. Dropkin

  3. Department of Urology and Epidemiology and Biostatistics, University of California – San Francisco, San Francisco, CA, USA

    Benjamin N. Breyer

  4. Department of Urology, University of California –Irvine, Irvine, CA, USA

    Faysal A. Yafi & David W. Barham

  5. Department of Urology, Vanderbilt University, Nashville, TN, USA

    Niels V. Johnsen

  6. Department of Urology, Columbia University, New York, NY, USA

    Gregory A. Joice

  7. Department of Urology, Herlev and Gentofte Hospital, Herlev, Denmark

    Mikkel Fode

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  1. Maia E. VanDyke
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  15. Allen F. Morey
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Contributions

MEV: survey design, survey implementation, data review, statistical analysis, manuscript preparation. WJS, LCH, BTL, BPF: survey design, survey implementation, data review. EGJ: data review, statistical analysis, manuscript preparation. BMD, BNB, NVJ, DWB, GAJ: survey design, manuscript review and preparation. FAY, MF, SJH, AFM: survey design, survey implementation, manuscript review and preparation.

Corresponding author

Correspondence to Maia E. VanDyke.

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Ethics approval

As this study collected no personal patient information and instead consisted of a survey of surgeon opinion, it was determined that ethics approval was not required.

Competing interests

Mikkel Fode: Boston Scientific (speaker). Steven Hudak: Boston Scientific (consultant). Allen Morey: Boston Scientific (consultant, speaker), Coloplast (consultant, speaker). Faysal Yafi: Coloplast (advisory board, speaker), Cynosure (consultant), Halozyme (advisory board, speaker), Masimo (intellectual property), Promescent (advisory board), sprout (consultant), Xialla (advisory board). The remaining authors have nothing to disclose.

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VanDyke, M.E., Smith, W.J., Holland, L.C. et al. Current opinions on the management of prolonged ischemic priapism: does penoscrotal decompression outperform corporoglanular tunneling?. Int J Impot Res 36, 62–67 (2024). https://doi.org/10.1038/s41443-023-00808-z

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