Acute ischemic priapism requires urgent intervention to restore detumescence. When initial pharmacologic and aspiration-based measures do not achieve the treatment goal, a defined next-line surgical approach is indicated.
The preceding line of management — intracavernosal phenylephrine injection and corporal aspiration, with or without saline irrigation — did not achieve the required goal of penile detumescence. This failure to reach that endpoint is the escalation trigger to the current protocol.
After failure of pharmacologic reversal and aspiration, the evidence-based approach involves a surgical shunting procedure targeting the distal corpora. The specific type of shunt selected — and whether additional manoeuvres are employed — is defined within the full protocol.
Goal: Penile detumescenceDOI: 10.1097/JU.0000000000002236
Clinicians should perform a distal corporoglanular shunt, with or without tunneling, in patients with acute ischemic priapism who have failed pharmacologic intracavernosal reversal and aspiration, with or without irrigation.
Analysis of the literature has shown that scalpel-based shunts (eg, Ebbehoj, Al Ghorab, Lue T Shunt) provide higher success than needle-based (ie, Winter's) shunts.
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