Penile prosthesis insertion is recommended for long-duration ischaemic priapism patients with refractory erectile dysfunction. There is a paucity of published data focusing on long term outcomes and quality of life reporting for patients in this setting. We contacted patients who had a post-ischaemic priapism penile prosthesis inserted in our department via telephone and conducted the previously validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Question items were answered on a Likert scale from 0–5 with satisfactory scores ≥3. Two-tailed Z-tests were used to determine satisfactory scores at significant levels (p < 0.05). We chose to add two additional questions on regret and feelings towards living the rest of their lives with a penile prosthesis. 167 patients had penile prostheses inserted post- ischaemic priapism between 2002–2022. Of these, 39 (23.4%; implants between 2007–2021) completed our questionnaire. The median age was 56 years (IQR 50–63) with a median time to questionnaire post-ischaemic priapism of 9 years (IQR 3–11). Analysing the QoLSPP mean item responses, the penile prosthesis resulted in satisfactory scores in 7 of 16 QoLSPP questionnaire items: device adequacy, device rapidity, device duration, meeting expectations, contentment with life, general well-being and sexual experience. The pooled mean score by domain was 3.7 ± 1.2 for functional, 3.3 ± 1.4 for relational, 3.2 ± 1 for social and 3.4 ± 1.1 for personal. Sub-group analysis demonstrated no significant difference in mean score by prosthesis type (inflatable versus malleable). Ten respondents cited specific reasons for how the penile prosthesis caused dissatisfaction. All 39 respondents (100%) answered ‘yes’, they did not regret penile prosthesis insertion as a treatment option and that they would be satisfied living the remainder of their lives with a device in situ. This study can be used to inform patient counselling, that penile prosthesis insertion is a suitable surgical technique to maintain sexual function post-ischaemic priapism.

Sleep-related painful erections (SRPE) and stuttering priapism (SP) are two rare disorders of penile erection. The aim of this article is to highlight the key similarities and differences between each condition and their management. We performed a literature review on the PubMed and Medline databases with a particular focus on the pathophysiology, risk factors, investigations and management of SRPE and SP. The main presenting feature in both SRPE and SP is sleep disruption due to brief episodes of painful erections that are typically self-limiting. SP is considered a subtype of ischaemic priapism and sickle cell disease is an important risk factor. These patients can develop major priapic episodes which require emergency management. The pathophysiology in SRPE is less well-defined and episodes only occur during sleep, detumesce quicker than in SP and do not progress to ischaemic priapism. Treatment aims are to prevent recurrence, but no established guidelines exist and the limited data is mainly from case studies. Management options in SP include hormonal analogues and α-agonists but in SRPE, baclofen has demonstrated the most consistent results. Our review suggests that SRPE and SP are two distinct conditions and further research is required to develop optimal management strategies for each disease process.

Abstract Aim Penile prosthesis (PP) insertion is recommended for patients experiencing long-duration ischaemic priapism to restore erectile function. In this setting, decision making is time critical, and clinicians must counsel appropriately. However, there is a paucity of published data on quality of life (QOL) outcomes. Aiming to equip clinicians to counsel in the acute setting, our objective was to conduct the largest study to date assessing QOL outcomes in post-priapism PP patients. Method We contacted patients who received post-priapism PP in our department via telephone and completed the previously validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Causes of dissatisfaction were collected anecdotally. Results 167 patients had PPs inserted post-priapism between 2002-2022. Of these, 39 (23%; implants between 2007-2021) completed our questionnaire. The median age of respondents was 55.7 years with a median time post-priapism event to study date of 9.1 years. At time of contact, 95% (37) of respondents were actively using their device. 82% (32) felt their PP had met their expectations, 74% (29) were satisfied with their sexual experience and the same number reported partner satisfaction. Causes of dissatisfaction related to changes in penis size as well as device choice. Conclusions PP insertion is a suitable surgical technique to maintain sexual function in patients’ post-priapism, for whom it can have a positive impact on sexual experience for both patient, and their partner. We noted dissatisfaction related to device choice and priapism complication symptoms. This emphasises the importance of managing patient expectation in regard to pathology and device options.

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II (MP76)1 May 2024MP76-03 CAN PENILE PROSTHESES PROVIDE SATISFACTORY QUALITY OF LIFE FOR PATIENTS POST-PRIAPISM? AN ANALYSIS OF LONG TERM OUTCOMES Katy Naylor, Aisling Looney, Isabel Dighero, Chloe Mount, Mark Johnson, Fiona Holden, David J. Ralph, and Philippa Sangster Katy NaylorKaty Naylor , Aisling LooneyAisling Looney , Isabel DigheroIsabel Dighero , Chloe MountChloe Mount , Mark JohnsonMark Johnson , Fiona HoldenFiona Holden , David J. RalphDavid J. Ralph , and Philippa SangsterPhilippa Sangster View All Author Informationhttps://doi.org/10.1097/01.JU.0001009484.98400.42.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction can be a life-changing consequence for patients with prolonged ischaemic priapism. If wishing to restore erectile function, they must make time-critical decisions regarding penile prosthesis (PP), for which they rely on their clinician for appropriate counselling. We aim to support clinicians in providing well-informed counsel by performing the largest study to date investigating long term quality of life (QoL) outcomes in ischaemic priapism patients receiving PP. Our study will contribute to this sparse area of research whilst helping improve patient outcomes and expectations. METHODS: The Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) validated questionnaire was used with the addition of two questions; whether the patient would opt to receive the PP again if returned to the original priapism event, and their feelings towards a future with a PP. Questionnaires were provided via telephone or email, depending on patient preference, and recorded in an electronic database alongside patient clinical and demographic information. Anecdotal feedback was also noted. RESULTS: 167 patients in our department had PP post-priapism between 2002-2022. 44 (26%) were contactable, of whom 39 (23%) completed the QoLSPP questionnaire. Median age of responders at the time of priapism was 55.7 years, with a median time from priapism to study date being 9.1 years. Median time interval between the priapism onset and PP insertion was 22 days. 23% responders had sickle cell disease. Initial PP was malleable in 64% responders and inflatable in the remaining 36%, with revision PP in 41%. QoLSPP results revealed at the time of contact, 95% were actively using their device, 82% felt their PP had met their expectations, 74% were satisfied with their sexual experience, and 73% reported partner satisfaction (if applicable). None reported regret in opting to have a PP, and 87% reported feeling satisfied living the rest of their life with a PP. Dissatisfaction mainly related to reduced penis size and preference for an inflatable device. CONCLUSIONS: Counselling men prior to PP insertion is vital. Where priapism is the cause of end stage erectile dysfunction, time is often short and men must make fast decisions. This study can be used to inform patients that PP insertion is a suitable surgical technique to maintain sexual function post-priapism. It has been shown to have a positive impact on sexual experience for both the patient, and reportedly their partner. Importantly, no patients regretted their decision to proceed with prosthesis implantation. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1243 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Katy Naylor More articles by this author Aisling Looney More articles by this author Isabel Dighero More articles by this author Chloe Mount More articles by this author Mark Johnson More articles by this author Fiona Holden More articles by this author David J. Ralph More articles by this author Philippa Sangster More articles by this author Expand All Advertisement PDF downloadLoading ...

IntroductionPenile prosthesis (PP) insertion is recommended for patients experiencing long-duration ischaemic priapism who wish to restore erectile function. However, little has been published focusing on quality of life (QOL) for such patients with post-priapism PP. This is the largest study to date assessing QOL outcomes in these patients.MethodsWithin our department, 167 patients received post-priapism PP between 2002–2022. 44 were contactable (implants between 2007–2021) and 39 completed an email/telephone validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire. Responses, as well as clinical and demographic data, were electronically logged. Two additional questions were asked regarding regrets and feelings regarding their future with a PP.ResultsMedian time to PP insertion was 22 days post-priapism. Of those who responded, 95% (37/39) actively use their prosthesis with 37% (14/39) primarily receiving an inflatable implant. No patients regretted receiving PP at the time of priapism, with 87% (34/39) satisfied with having a PP for the remainder of their life. Regarding pleasure, 74% (29/39) had satisfaction relating to experience and penetration half the time or more. 82% (32/39) felt their PP had met expectations at least half the time. 27/37(73%) reported partner satisfaction with the PP half the time or more.ConclusionsPP insertion can positively maintain sexual function in such patients post-priapism. This study revealed that the majority of men who received PP post-priapism, and seemingly their partners, were satisfied. Every patient agreed they would still undergo PP implantation if returned to their priapism event again.

INTRODUCTION:Fournier's gangrene is a urological emergency, comprising of type I necrotizing fasciitis resulting in anatomic defects affecting the perineum, perianal region, and external genitalia in both men and women, often requiring reconstruction. OBJECTIVES:The aim of this article is to provide a comprehensive review of the different reconstructive techniques for Fournier's gangrene. METHODS:A literature search was performed on PubMed with the search terms "Fournier"s gangrene" "genital reconstruction" and "Fournier's gangrene phalloplasty." The European Association of Urology's guidelines on Urological infections were also consulted for recommendations. RESULTS:Reconstructive procedures include primary closure, scrotal advancement flaps, fasciocutaneous flaps, myocutaneous flaps, skin grafts, and phalloplasty. There is insufficient evidence to support that flaps lead to better outcomes than skin grafts, or vice versa, particularly for scrotal defects. Both techniques have been shown to have satisfactory aesthetic results, with good skin color match and natural scrotal contour. With regards to phalloplasty, there is a lack of data specifically relating to Fournier's gangrene, as most articles were addressed toward gender affirmation surgery. Furthermore, there is a lack of guidelines in both the immediate and reconstructive management of Fournier's gangrene. Lastly, the outcomes reported following reconstructive surgery have been objective rather than subjective, meaning that patient satisfaction was rarely recorded. CONCLUSION:Further research is required in the field of reconstructive surgery specific to Fournier's gangrene, which should also take into consideration patient demographics and subjective reports regarding cosmesis and sexual function. Michael P, Peiris B, Ralph D, et al. Genital Reconstruction following Fournier's Gangrene. Sex Med Rev 2022;10:800-812.

Introduction: Post-radical prostatectomy erectile dysfunction (post-RPED) is a common and potentially devastating complication. The role of PDE5-inhibitors (PDE5-Is) in post-RPED is controversial and invasive pharmacological treatments are associated with poor long-term compliance. Vacuum erection devices (VEDs) are a non-pharmacological alternative. Little data regarding VED efficacy and associated patient satisfaction in post-RPED exists. This study aimed to investigate the outcomes of VED therapy in a post-robot assisted radical prostatectomy (post-RARP) population. Methods: All men who underwent RARP at a single centre between February 2015 and October 2017 attended a nurse-led holistic-needs-assessment (HNA) appointment at 10 weeks post-RARP. All men identifying ED as a concern at HNA were offered dedicated nurse-led post-RPED clinic and VED clinic appointments. A cross-sectional survey of patient reported outcomes in these men was performed. Results: In total 137/539 (25%) men reported ED as a concern at HNA. All 137 men attended the VED clinic, 124/137 (90%) responded to the survey. Commonest reason for choosing VED therapy was for combined psychological, penetration and lengthening purposes (48%). Median time from RARP to VED clinic and from VED clinic to survey was 122 days (range 56–595) and 462 days (range 66–932) respectively. At survey 88/124(70.9%) reported continued use of VED, 69/88 (78%) of this group perceived VED treatment to be successful. Of those who had stopped using VED, 7/36 (19%) felt it had been successful. Key reasons for discontinuation were either because men felt it ineffective (13/36 (37%)) or disliked the device (10/36 (29%)). Conclusion: VED therapy is an effective treatment for men with post-RARP ED that is well tolerated with good short- to medium-term compliance. Up to two-thirds of men may find overall satisfaction with their post-RPED after VED therapy. Level of Evidence: 3

BACKGROUND:A chief complaint of men with stuttering priapism (SP) and sleep-related painful erections (SRPE) is bothersome nocturnal erections that wake them up and result in poor sleep and daytime tiredness. SP and SRPE are rare entities that have similarities in their clinical features, but that require different treatment approaches. AIM:The aim of this study was to describe the clinical features, investigations, and effective management options for men with SP and SRPE. METHODS:Retrospective cohort study of 133 men with bothersome nocturnal painful erections that attended a tertiary andrology unit between 2004 and 2018. These men were divided into 3 groups. Group 1 (n = 62) contains men with sickle cell SP; group 2 (n = 40) has men with non-sickle cell SP and group 3 (n = 31) contains men with SRPE. OUTCOME:To determine the effectiveness of medical and surgical treatments for men with SP and SRPE. RESULTS:Hydroxyurea and automated exchange transfusion were the most effective treatment options in the sickle cell SP group. Hormonal manipulation and α-agonist therapies were effective in both SP cohorts (groups 1 and 2). Baclofen was the most effective therapy in men with SRPE. For men who failed medical management, implantation of a penile prosthesis resulted in complete resolution of the symptoms in men with SP (groups 1 and 2). Surgical management (penile prosthesis implantation and embolization) did not improve the patients' symptoms in the SRPE group. CLINICAL IMPLICATIONS:This study differentiates between sickle cell SP, non-sickle cell SP, and SRPE and describes effective treatment options for each group. STRENGTHS & LIMITATIONS:This is the largest cohort study for both SP and SRPE, respectively. Limitations include its retrospective nature and single-center experience. CONCLUSION:Managing men in these 3 groups differently and in accordance with the proposed treatment pathway provides a more structured approach to the management of these rare conditions. Johnson M, McNeillis S, Chiriaco G, et al. Rare Disorders of Painful Erection: A Cohort Study of the Investigation and Management of Stuttering Priapism and Sleep-Related Painful Erection. J Sex Med 2021;18:376-384.

INTRODUCTION:Priapism is rare yet has the potential to inflict significant suffering on patients, often with lasting consequences such as erectile dysfunction, corporal muscle necrosis, and a loss of sexual function. Although rare, it is a pathology that has received little focus in the literature, particularly that caused by malignancy, and it is in this form that the long-term prognosis becomes particularly poor. AIM:This review looks at malignant priapism in detail moving from the etiology and pathogenesis through investigations and management to provide an up-to-date picture. METHODS:In so doing, more than 30 articles are reviewed and examined from databases such as PubMed. Significant cases are provided as examples to provide a comprehensive review of a topic that receives little attention but can cause significant patient morbidity. MAIN OUTCOME MEASURE:The main outcome measure was the use of aspiration, sympathomimetics, and surgery as the main treatment modalities and how each one is used with regard to both the underlying etiology of the priapism and also the prognosis. We look at the need for treatment and how that relates to quality of life and erectile function thereafter. RESULTS:Solid tumor invasion-both primary and secondary-and hematologic malignancies represent the key etiologies of malignant priapism and aggressive treatment is needed. Recovery of erectile function can occur if intracavernosal phenylephrine is quickly administered or distal shunts are placed; however, the prognosis is often poor, and subsequent chemotherapy treatment is often required. CONCLUSION:The importance of a clear history and examination cannot be understated, and although the prognosis is often poor, this review hopes to give clinicians better understanding to be able to recognize malignancy as a potential cause of priapism. Ralph O, Shroff N, Johnson MJ, et al. Malignancy: A Rare, Important and Poorly Understood Cause of Priapism. J Sex Med 2021; 9:312-319.

INTRODUCTION AND OBJECTIVE:The goal of genital female-to-male (FTM) gender affirming surgery is to create an aesthetically acceptable phallus to allow voiding while standing and penetrative sexual ...

Reconstructive surgery of the penis holds many unique challenges due to the unique physiological properties of the tissues. Much of the effort involved therefore goes to preserving as much of the native tissue as possible whilst novel and creative methods have been adopted to repair defects and in creation of neophallus. A search of the PubMed database was carried out using the following keywords: ‘penile trauma’, ‘penile cancer’, ‘lichen sclerosus’, ‘glansectomy’, ‘glans resurfacing’, ‘penile-sparing surgery’, ‘micropenis’, ‘aphallia’, ‘female-to-male sex reassignment surgery’, ‘scrotal flap’ and ‘genital lymphoedema’. Results for glans resurfacing in treating cancer showed low local recurrence rates at 0–10% whilst 90% of lichen sclerosus patients reported complete resolutions of pain and pruritis. For repairs of penile shaft skin defects the literature supports the use of full-thickness skin graft and pedicled scrotal flaps. The radial artery-based forearm free flap remains the best option for neophallus creation in terms of function, sensation and cosmesis but unfortunately leaves a disfiguring scar and involves multiple stages. Some novel techniques have been developed to circumvent these issues and are discussed. This article presents an update on the important developments in the field of penile reconstructive surgery.

Buried penis has a significant impact on quality of life affecting voiding and sexual function. Central and suprapubic deposition of adipose tissue related to obesity is a common cause. This video shows the surgical approach of a complex case of buried penis managed with a suprapubic fat pad excision and simultaneous malleable penile prosthesis insertion. We present a case of buried penis in a morbidly obese patient(BMI:43) with a history of two previous gastric bypass surgery and an apronectomy, affecting micturition and sexual function. A skin incision is made with a transverse incision at the level of the anterior-superior iliac spine and a curvilinear inferior border. The apex of the inferior border should be approximately 2 finger breadth above the level of the penopubic junction. The incision is extended down to the rectus sheath and the spermatic cords at the lateral boundaries and the penile shaft at the midline are exposed. A malleable implant is inserted using the infrapubic approach and a split skin graft(SSG) harvested to replace the unhealthy penile shaft skin. The dermis of the skin edges are secured to the rectus sheath with 0/0 vicryl sutures and the wound is closed in layers.

Ischaemic priapism (IP) is characterised by a persistent, painful penile erection lasting for >4 h. Many causes of IP have been identified including haematological dyscrasias (particularly, sickle cell disease), drugs and rarely malignancy. There are also a large proportion of men, in which no aetiology is identified. Identification of men at risk for malignancy provides a diagnostic challenge to the clinicians looking after these patients. All cases of IP between 2007 and 2017 at a single tertiary andrology unit were identified. The case notes and electronic records of these patients were reviewed to identify cases of malignant priapism. Men with idiopathic IP were used as a control group for comparative statistics. In total, 412 men with IP were identified, 202 of which had idiopathic IP. Within this group, the prevalence of malignant priapism was 3.5% ( n = 11). MP secondary to local invasion or penile metastases occurred in seven of the 11 men (bladder × 3, prostate, lung, urethral and chondrosarcoma of the pelvis). MP secondary to haematological malignancy occurred in the remaining four (chronic myeloid leukaemia × 2, chronic lymphocytic leukaemia, and myelodysplasia). IP was the initial presentation of malignancy in seven of the patients (64%). An abnormally low haemoglobin value (reference range 130–180 g/dl) was found in 82% ( n = 9) of the men with MP. The mean haemoglobin value in men with MP was 109.64 ± 20.30 g/dl compared to the control of 131.87 ± g/dl. This difference was considered highly significant p = 0.0046. Men with MP also appear to have a very poor prognosis with an 18-month mortality of 64% ( n = 7). Malignancy is a rare and important cause of IP. A low haemoglobin is a predictor of malignancy and warrants further investigation in IP.

To evaluate the efficacy, safety and predictive factors of collagenase clostridium histolyticum (CCH) in the treatment of Peyronie's disease (PD) using the modified treatment protocol. A prospective study of 89 men with PD that completed at least 1 course (3 injections) of CCH treatment at a single centre. The majority (77.5%) received 1 course of treatment, with 16.9%(n=15) and 5.6%(n=5) completing 2 or 3 courses respectively. The angle of curvature assessment after PGE1 injection, the International Index of Erectile Function (IIEF), Peyronie's Disease Questionnaire (PDQ) and Global Assessment (GAPD) were completed at baseline and 4 weeks after the last injection of each course. Co-morbidities and risk factors for PD were recorded at baseline. The range of curvature improvement (RI) was assessed as improvement<14°; 15°-20°; and >21°. The baseline curvature was 54±17.3°. There was a mean improvement following 1 treatment course of 31%(17±10.4°). Of those men that opted for a second treatment course there was a 36% improvement from baseline (23.3±10°). After a third course of CCH treatment there was a 52.3% improvement from baseline (35 ± 9.4°). There was significant improvement in IIEF and PDQ domains. CCH was well tolerated with only one patient experiencing significant side effects (penile fracture). Overall 11%(n=10) patients experienced local and transient mild side effects. There was no association between the number of treatment courses and severe side effects. Following treatment with CCH, 9%(8/89) of the men opted for surgical correction. Men with a greater curvature(>70;n=22) responded significantly better to CCH than men with minor curvature (<45;n=36). Patients with curvature<45° seemed to have improvement<14°(p<0.0001) and patients with curvatures>70° to have improvement>20°(p=0.02). Men that had PD for more than 12 months (n=46) responded significantly better to CCH and were more satisfied regarding the treatment than men with PD for less than 12 months (n=41). Twenty out of 46(43.5%) patient affected by PD for more than 12 months had a improvement>21°vs7/41(17%) men with PD for less than 12 months(p=0.007). Micro-calcification on US(p=0.8) and point of injection(p=0.9) appeared not to be correlated to the outcome.

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II (PD44)1 Apr 2019PD44-01 A COMPARISON BETWEEN EARLY AND DELAYED PENILE PROSTHESIS INSERTION IN MEN WITH REFRACTORY ISCHAEMIC PRIAPISM Mark Johnson*, Marcus Hallerstrom, Giovanni Chiriaco, Thomas Johnson, Evangelos Zacharakis, Amr Raheem, Andrew Nim Christopher, Asif Muneer, Giulio Garaffa, and David Ralph Mark Johnson*Mark Johnson* More articles by this author , Marcus HallerstromMarcus Hallerstrom More articles by this author , Giovanni ChiriacoGiovanni Chiriaco More articles by this author , Thomas JohnsonThomas Johnson More articles by this author , Evangelos ZacharakisEvangelos Zacharakis More articles by this author , Amr RaheemAmr Raheem More articles by this author , Andrew Nim ChristopherAndrew Nim Christopher More articles by this author , Asif MuneerAsif Muneer More articles by this author , Giulio GaraffaGiulio Garaffa More articles by this author , and David RalphDavid Ralph More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556615.02106.6cAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: There is still a lack of consensus in the literature about the timing of penile (PP) prosthesis surgery following refractory ischaemic priapism (IP). The aim of this study is to compare the long-term results of early vs delayed PP insertion in this group. METHODS: A total of 126 men underwent penile prosthesis surgery for refractory IP between 1999 and 2017. Early PP insertion (<3 weeks from onset of priapism) was carried out in 88 men with a mean duration of 6.5 days (range 3 to 21 days) from the onset of priapism. Delayed PP insertion (>3 weeks since the onset of priapism) was carried out in 38 men with a mean duration of 6.7 months (range 0.75 to 25 months) since the onset of priapism. The results for complications, sexual ability and satisfaction were assessed at follow-up outpatient visits. RESULTS: In the early group, a malleable and an inflatable PP was implanted in 83 and 5 patients, respectively. After a mean follow-up of 17.8 months (range 3 to 76 months), 8% required (n = 7) required revision surgery due to infection (n = 5), curvature (n = 1) or erosion (n = 1). Patient's satisfaction rate was 94.3% and the ability to have sexual intercourse was 93.2%. In the delayed group, a malleable PP was inserted in 19 patients and an inflatable PP in the remaining 19. After a mean follow-up of 18.6 months (range 3 to 28 months), 23.7% (n = 9) patients required revision surgery due to infection (n = 6), erosion (n = 2) or mechanical failure (n = 1). Overall 86.8% (n = 32) could have sexual intercourse and patient satisfaction rates were 60.5% (n = 23). There was a significant difference (p = < 0.001) between the complication and patient satisfaction rates between the early and delayed groups. CONCLUSIONS: Early implantation of a penile prosthesis has a significantly lower complication and higher patient satisfaction rate compared to a delayed procedure and should be the preferred option in men with refractory IP. Source of Funding: none London, United Kingdom© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e821-e821 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mark Johnson* More articles by this author Marcus Hallerstrom More articles by this author Giovanni Chiriaco More articles by this author Thomas Johnson More articles by this author Evangelos Zacharakis More articles by this author Amr Raheem More articles by this author Andrew Nim Christopher More articles by this author Asif Muneer More articles by this author Giulio Garaffa More articles by this author David Ralph More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologySexual Function/Dysfunction: Surgical Therapy II (PD44)1 Apr 2019Sexual Function/Dysfunction: Surgical Therapy II (PD44) View All Author Informationhttps://doi.org/10.1097/01.JU.0000558628.50385.b0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Expand All Advertisement PDF downloadLoading ...

Priapism is a urological emergency that is defined as a prolonged penile erection lasting more than 4 h, remaining despite orgasm and in the absence of sexual stimulation. Without prompt and complete detumescence, time-dependent changes occur to the smooth muscle of the corpus cavernosa that can result in permanent erectile dysfunction and penile deformity (curvature, shortening and loss of girth). The diagnosis is confirmed with a hypoxic and acidotic blood sample from the corpus cavernosa. The trapped blood inside the corpus cavernosa is aspirated and can be irrigated with 0.9% normal saline. Intracavernosal injection of a sympathomimetic agent is used to cause smooth muscle contraction if the previous measures fail. Failure or recurrence of priapism following these conservative measures is an indication for surgical management. Shunt procedures that create a connection with the corpus cavernosa and a neighbouring structure are often used first line. Multiple shunt procedures have been described and these are summarised in this article. Distal shunt procedures are the most commonly used as they are easier to perform and seem to have at least comparable detumescence and potency rates. Refractory or prolonged (>48 h) ischaemic priapism maybe an indication of immediate placement of a penile prosthesis.

Men with stuttering priapism often experience almost daily prolonged and painful sleep-related erections. The aim of this study is to evaluate the clinical features and treatment options of this rare and poorly understood condition. A cohort study of 133 men that attended outpatients or the emergency department at a tertiary andrology unit between 2004 and 2017. Data was collected retrospectively in 102 of the patients (seen and/or discharged between 2004 - 2015) and prospectively in 31 patients (Seen between 2015 – 2017). The effectiveness of each treatment option was classified into; no effect, partial response and complete remission. Many of the patients have tried more than one of the available treatments. Aetiological factors included haemoglobinopathy (n = 67) (sickle cell disease [SCD] and thalassemia), drugs (n = 8), neurogenic causes (n = 3) homocystinuria (n = 1), haemodialysis (n = 1), trauma (n = 1), following surgery (n = 1) and idiopathic (n = 51). The mean (SE) age of the patients in the cohort is was 40.5 (1.2) years and age at diagnosis was 30.8 (1.2) years. There was a significant (p = 0.0001) bimodal age distribution at diagnosis between men with and without a haemoglobinopathy (24.5 vs 37.4 years). Within this series, numerous treatment options were effective at reducing the number and length of priapism episodes and are highlighted in Table 1.