https://doi.org/10.4081/aiua.2021.3.356

Immediate insertion of a soft penile prosthesis as a new option for a safe and cost-effective treatment of refractory ischemic priapism

Vol. 93 No. 3 (2021)
Submitted: March 2, 2021
Accepted: April 20, 2021
Published: October 1, 2021
Priapism, Soft tumors, Penile prosthesis, Virilis, Ischemic priapism, Early implantation
Abstract Views: 771
PDF: 390
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Authors

Franco Palmisano
franco.palmisano@hotmail.it
ASST Fatebenefretalli-Sacco, Luigi Sacco University Hospital, Department of Urology, Milan, Italy.
Valerio Vagnoni
Andrology Unit, Department of Urology and Gynecology, Sant’Orsola University Hospital, Bologna, Italy.
Alessandro Franceschelli
Andrology Unit, Department of Urology and Gynecology, Sant’Orsola University Hospital, Bologna, Italy.
Giorgio Gentile
Andrology Unit, Department of Urology and Gynecology, Sant’Orsola University Hospital, Bologna, Italy.
Fulvio Colombo
Andrology Unit, Department of Urology and Gynecology, Sant’Orsola University Hospital, Bologna, Italy.

Objective: The aim of this study is to assess the management of refractory ischemic priapism (IP) by the immediate insertion of a soft penile prosthesis (sPP).
Patients and methods: We identified men affected by IP who underwent early sPP placement from May 2017 to October 2019. All patients underwent a detailed medical history review; intraoperative, postoperative features and adverse events were recorded. We evaluated the penile lengthening and bending, presence of complementary erection, ability to have sexual intercourse, postoperative sexual life satisfaction (International Index of Erectile Function [IIEF] questionnaire - question number 5). A cost-analysis was included.
Results: A total of six patients were identified. Median time (range) since onset was 78 (48-108) hours with a mean age (SD) of 33 (6.9) years. Median operative time (range) was 82 minutes (62-180). No complications were recorded. Median follow- up was 9 months (range 3-17). No significant loss of penile length, neither penile angulation was recorded. Despite a transient reduction of penile sensitivity, all patients reported satisfactory sexual intercourse (mean score question number 5 from IIEF-5 of 4). The cost of sPP was € 1769,00 with a surgeryrelated reimbursement fee from the National Health System of € 3856,75.
Conclusions: The insertion of a sPP for patients with refractory IP results in immediate pain relief, preservation of sexual function and penile size, with a higher surgery reproducibility in an emergency. In addition to this, financial and resource burdens of IP on the health-care system can be potentially reduced.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
Salonia A, Eardley I, Giuliano F, et al. EAU Guidelines on Priapism. Edn. presented at the EAU Annual Congress Madrid 2015. 978-94-92671-07-3. Publisher: EAU Guidelines Office. Place published: Arnhem, The Netherlands. http://www.uroweb.org/guidelines/online-guidelines/.
El-Bahnasawy MS, Dawood A, Farouk A. Low-flow priapism: risk factors for erectile dysfunction. BJU Int. 2002; 89:285-90. DOI: https://doi.org/10.1046/j.1464-4096.2001.01510.x
Spycher MA, Hauri D. The ultrastructure of the erectile tissue in priapism. J Urol. 1986; 135:142-7. DOI: https://doi.org/10.1016/S0022-5347(17)45549-2
Lue TF, Broderick G. Evaluation and nonsurgical management of erectile dysfunction and priapism. In Campbell MF, Retik AB eds, Campbell’s Urology, 7th edn. Philadelphia, PA: WB Saunders Co., 2002, pp. 1619-71.
Burnett AL, Sharlip ID. Standard operating procedures for priapism. J Sex Med. 2013; 10:180-94. DOI: https://doi.org/10.1111/j.1743-6109.2012.02707.x
Reddy AG, Alzweri LM, Gabrielson AT, et al. Role of penile prosthesis in priapism: a review. World J Mens Health. 2018; 36:4-14. DOI: https://doi.org/10.5534/wjmh.17040
Ralph DJ, Garaffa G, Muneer A, et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur Urol. 2009; 56:1033-8. DOI: https://doi.org/10.1016/j.eururo.2008.09.044
Zacharakis E, Raheem AA, Freeman A, et al. The efficacy of the T-shunt procedure and intracavernous tunneling (snake maneuver) for refractory ischemic priapism. J Urol. 2014; 191:164-8. DOI: https://doi.org/10.1016/j.juro.2013.07.034
Zacharakis E, Garaffa G, Raheem AA, et al. Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation. BJU Int. 2014; 114:576-81. DOI: https://doi.org/10.1111/bju.12686
Broderick GA, Gordon D, Hypolite J, Levin RM. Anoxia and corporal smooth muscle dysfunction: a model for ischemic priapism. J Urol. 1994;151:259-62. DOI: https://doi.org/10.1016/S0022-5347(17)34928-5
Sedigh O, Rolle L, Negro CL, et al. Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature. Int J Impot Res. 2011; 23:158-64. DOI: https://doi.org/10.1038/ijir.2011.23
Salem EA, El Aasser O. Management of ischemic priapism by penile prosthesis insertion: prevention of distal erosion. J Urol. 2010;183:2300-3. DOI: https://doi.org/10.1016/j.juro.2010.02.014
Martínez-Salamanca JI, Mueller A, Moncada I, et al. Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review. J Sex Med. 2011; 8:1880-9. DOI: https://doi.org/10.1111/j.1743-6109.2011.02281.x
Mishra K, Loeb A, Bukavina L, et al. Management of priapism: a contemporary review. Sex Med Rev. 2020;8:131-139. DOI: https://doi.org/10.1016/j.sxmr.2019.01.001
Zacharakis E, De Luca F, Raheem AA, et al. Early insertion of a malleable penile prosthesis in ischaemic priapism allows later upsizing of the cylinders. Scand J Urol. 2015; 49:468-471. DOI: https://doi.org/10.3109/21681805.2015.1059359
Subrini L. Flexible penile implants in the restoration of erectile function. Ann Urol. 1993; 27:183-91.
Austoni E, Colombo F, Romanò AL, et al. Soft prosthesis implant and relaxing albugineal incision with saphenous grafting for surgical therapy of Peyronie's disease: a 5-year experience and long-term follow- up on 145 operated patients. Eur Urol. 2005; 47:223-9. DOI: https://doi.org/10.1016/j.eururo.2004.10.004
Zaazaa A, Mostafa T. Spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile prosthesis implantation. J Sex Med. 2019; 16:474-478. DOI: https://doi.org/10.1016/j.jsxm.2019.01.012
Tausch TJ, Zhao LC, Morey AF, et al. Malleable penile prosthesis is a cost-effective treatment for refractory ischemic priapism. J Sex Med. 2015; 12:824-6. DOI: https://doi.org/10.1111/jsm.12803

How to Cite

Palmisano, F., Vagnoni, V., Franceschelli, A., Gentile, G., & Colombo, F. (2021). Immediate insertion of a soft penile prosthesis as a new option for a safe and cost-effective treatment of refractory ischemic priapism. Archivio Italiano Di Urologia E Andrologia, 93(3), 356–360. https://doi.org/10.4081/aiua.2021.3.356

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