Favorable Multi-Institutional Experience with Penoscrotal Decompression for Prolonged Ischemic Priapism.

OBJECTIVES To report our multi-institutional experience using penoscrotal decompression (PSD) for surgical treatment of prolonged ischemic priapism (PIP). MATERIALS AND METHODS We retrospectively reviewed clinical records for PIP patients treated with PSD from 2017-2020. Priapisms were confirmed as ischemic based on clinical presentations and cavernosal blood gas abnormalities. All patients failed irrigation and injection of alpha agonist prior to PSD. Patient characteristics, perioperative parameters and outcomes, and changes in International Index of Erectile Function (IIEF) scores were evaluated. RESULTS We analyzed 25 patients that underwent a total of 27 PSD procedures. Mean time of priapism at initial presentation was 71.0 hours. All patients failed irrigations and injections, while 48.0% of patients (12/25) also failed corporoglanular shunts prior to PSD. Of the 10 patients who underwent unilateral PSD, two (20.0%) had priapism recurrence. Both were treated with bilateral PSD with prompt and lasting detumescence. Among the 15 patients undergoing primary bilateral PSD, none had priapism recurrence. Of the 15 patients with documented sexual function status at last follow-up, nine (60%) reported spontaneous erectile function adequate for penetration, while six (40%) patients reported erectile dysfunction. Median decrease in IIEF-5 score was 3.5 points (IQR: 0-6.75) after PSD. Two patients underwent uneventful inflatable penile prosthesis placement following PSD. CONCLUSIONS PSD presents a simple, safe, highly effective, and easily reproducible procedure for resolution of PIP. PSD should be considered as a viable salvage or alternative strategy to corporoglanular shunt procedures.