V8-13: ACUTE INSERTION OF PENILE PROSTHESES FOR REFRACTORY ISCHEMIC PRIAPISM
VideoIntroductions and Objectives
Patients with refractory ischemic priapism (RIP) frequently develop severe erectile dysfunction (ED) and ultimately require penile prosthesis insertion. We describe the technique of malleable penile prosthesis (MPP) insertion in the acute setting of refractory ischemic priapism.
We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007-2013. Data analyzed included duration of erection, number of ER visits, hospital admissions, days of hospitalization and postoperative course. Costs were estimated using standard Medicare reimbursement rates. Surgery began with a 2-in longitudinal penoscrotal incision due to the need for larger corporotomies necessary to facilitate MPP insertion. Three pairs of traction sutures of 2-0 PDS were placed along each corporal body. A 3-cm corporotomy was made, allowing for escape of ischemic blood and irrigation of clot. Rosello cavernotomes (Coloplast, Minneapolis, MN) were used to sequentially dilate the corpora and remove damaged intracavernosal tissue. To minimize the risk of distal erosion, the MPP was undersized by 1 cm, so that the cylinder tip resided just proximal to the coronal sulcus. A drain was placed overnight. The corporotomies and wound were closed in multiple layers with absorbable sutures.
During the study period, 14 men underwent MPP placement acutely for refractory priapism for sickle cell anemia, medication-induced or idiopathic RIP. Average preoperative duration of RIP was 82 hours (range 3.5-240) with considerable consumption of health care resources [average $83,818 estimated cost, 4 emergency room visits (range 1-27), 2 hospital admissions (range 1-5), 1.5 shunt procedures (range 1-3), 5 irrigation and drainage procedures using phenylephrine injection (range 2-20) and 5 hospital admission days (range 2-14)]. All patients were discharged within 24 hours of MPP surgery.
MPP insertion is efficacious for the immediate resolution of RIP and treatment of ED, which subsequently develops in many patients. MPP also has potential cost and resource benefits.