Men with priapism may benefit from immediate penile prothesis implantation (PPI), according to a recent review of medical literature.
Immediate PPI, occurring during the priapism episode itself, was first discussed in the late 1980s and became more common in the late 2000s. The approach is “technically easier” and has fewer complications than delayed surgery, the authors concluded.
Their review began by discussing three types of priapism:
- Ischemic priapism. Marked by pain and rigidity, ischemic priapism can lead to necrosis (cell death) if not treated quickly. Immediate PPI could be helpful after 36 hours, as permanent erectile dysfunction (ED) becomes more likely at this duration. It may also be a treatment consideration in patients with shorter-term priapism if shunt surgery has been unsuccessful, or if patients had erectile difficulty before priapism.
- Recurrent priapism. Men with this type of priapism generally have shorter, but repeated, episodes that cause pain and may lead to ED. Penile implants might reduce the need for repeated emergency department visits for men with recurrent priapism, but implantation as a prevention tactic should only be a “last resort” if ED is imminent.
- Non-ischemic priapism. With this type of priapism, the erection is not painful or rigid, and men don’t usually require emergency care. However, PPI could be appropriate for these patients in the long term.
The authors explained that immediate surgeries are easier to perform, as there is typically less fibrosis, which develops over time. However, it is important that the procedures be handled by experienced surgeons. Malleable and inflatable devices are both options. Some men may decide to “exchange” a malleable implant for an inflatable version later on.
Patients may choose delayed PPI after undergoing conservative treatments (e.g., phosphodiesterase type 5 inhibitors or vacuum devices), although delayed procedures have higher complication rates and lower satisfaction rates. However, there is no consensus on the best way to manage corporal fibrosis, the authors said.
Infection and erosion were the most common complications associated with immediate PPI, the authors said.
In general, satisfaction rates for penile implants are over 90% for both patients and partners. Satisfaction is often influenced by surgical complications, penile shortening, and the type of prosthesis used. Still, the authors were unable to determine an exact overall satisfaction rate because of the different treatment techniques and satisfaction assessments used across studies.
Malleable implants appear to be more cost effective, but they also have lower satisfaction rates.
Overall, “PPI is the most effective treatment for post-priapism ED and can be performed immediately or delayed,” the authors concluded. “The paradigm is shifting toward immediate PPI in managing priapism.”
Their article was published online in September in Sexual Medicine Reviews.
Sexual Medicine Reviews
Yücel, Ömer Barış MD, et al.
“Penile Prosthesis Implantation in Priapism”
(Full-text. Published online: September 12, 2017)