Surgical Management of Ischemic Priapism

Introduction. Surgery is a mainstay in the management of ischemic priapism. The surgical armamentarium for this condition has recently been expanded with the introduction of several innovative procedures. Aim. To review surgical procedures offered in the treatment of ischemic priapism and present a rational framework for their use. Methods. Medline searches through July 2010 were conducted using the terms priapism, surgery, shunt, and prosthesis. Main Outcome Measure. Expert opinion was based on review of the medical literature related to this subject matter. Results. A host of surgical procedures exist to address the genital complications of both acute presentations of ischemic priapism and its non-acute pathologic sequelae, which include penile deformities and erectile dysfunction. For the former, the intervention is used principally in an emergent context with the intention to relieve the acute pathologic effects of the condition and preserve erectile function. For the latter, the intervention is aimed generally toward restoring anatomic normalcy and the functional ability to perform sexual intercourse. A rational framework for surgical management, based on the circumstances of the clinical presentation, is described. Conclusions. The surgical management for ischemic priapism has evolved with the application of a host of surgical procedures. These procedures address acute and non-acute genital complications of the condition and are intended to retain or restore sexual ability effectively and safely. They can be applied using a rational clinical management framework.