The Challenges of Prolonged Ischemic Priapism Treatment: Insights from the 27th SMSNA Annual Meeting
On Saturday, October 10, at the 27th Annual SMSNA Fall Scientific Meeting, Dr. Juan Andino discussed the surgical challenges of prolonged ischemic priapism, emphasizing the importance of early intervention and the potential benefits of penoscrotal decompression. Dr. Andino suggested that patients with ischemic priapism lasting 20 hours should already be considered complex cases, rather than waiting until 24 hours. He emphasized that his primary goal is immediate decompression, with penile prosthesis placement considered depending on the duration of priapism and the likelihood of erectile function recovery.
Dr. Andino began by examining the different international recommendations based on the duration of priapism, including thresholds of 24 and 36 hours. The goal of traditional shunt surgery is to create a passage between the corpora cavernosa and the glans to drain trapped blood. Dr. Andino highlighted penoscrotal decompression as a promising alternative, which drains blood through an opening in the proximal corpora cavernosa while sparing the glans. A systematic review found that penoscrotal decompression achieved detumescence in 89.3% of cases, with some patients preserving erectile function.
Dr. Andino also discussed the importance of preserving penile structures and understanding how surgical decisions may affect erectile function and quality of life. He referenced the European Association of Urology (EAU) guidelines and the AUA/SMSNA recommendations, noting the evolving evidence surrounding penoscrotal decompression. Another study identified the duration of priapism as the strongest predictor of erectile dysfunction. Current AUA/SMSNA guidelines allow clinicians to consider penile prosthesis placement after more than 36 hours of untreated ischemic priapism or when shunting procedures have failed. However, Dr. Andino emphasized the importance of earlier intervention to improve the chances of preserving erectile function.
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