Arthur L Burnett1, Phillip M Pierorazio2. 1. Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Electronic address: aburnett@jhmi.edu. 2. Department of Urology, The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Abstract
INTRODUCTION: Current surgical shunting procedures for major ischemic priapism do not always effectively resolve acute presentations of this disorder. AIM: To evaluate a modification of the Al-Ghorab distal penile corporoglanular shunt surgery for ischemic priapism. METHODS: Three previously potent men (48, 43, 40 years of age) presented with major ischemic priapism episodes (5, 2, and 6 days in duration, respectively), which were refractory to clinical management including sympathomimetic intracavernosal treatments, intracorporal aspiration and saline irrigation, and penile shunt surgery attempts. We offered a surgical technique for facilitating corporal blood evacuation by retrograde insertion of a cavernosal dilator through the excised tunical windows of the distal corpora cavernosa after transglanular incision. MAIN OUTCOME MEASURES: Clinical evaluation of priapism resolution and erection recovery. RESULTS: All men achieved successful resolution of priapism, with meaningful erection recovery assessable in one man. Conclusions. The modified Al-Ghorab corporoglanular shunt surgery appears to offer an advantageous management approach to resolve ischemic priapism, particularly for cases refractory to first-line management.
INTRODUCTION: Current surgical shunting procedures for major ischemic priapism do not always effectively resolve acute presentations of this disorder. AIM: To evaluate a modification of the Al-Ghorab distal penile corporoglanular shunt surgery for ischemic priapism. METHODS: Three previously potent men (48, 43, 40 years of age) presented with major ischemic priapism episodes (5, 2, and 6 days in duration, respectively), which were refractory to clinical management including sympathomimetic intracavernosal treatments, intracorporal aspiration and saline irrigation, and penile shunt surgery attempts. We offered a surgical technique for facilitating corporal blood evacuation by retrograde insertion of a cavernosal dilator through the excised tunical windows of the distal corpora cavernosa after transglanular incision. MAIN OUTCOME MEASURES: Clinical evaluation of priapism resolution and erection recovery. RESULTS: All men achieved successful resolution of priapism, with meaningful erection recovery assessable in one man. Conclusions. The modified Al-Ghorab corporoglanular shunt surgery appears to offer an advantageous management approach to resolve ischemic priapism, particularly for cases refractory to first-line management.