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Inicio Actas Urológicas Españolas (English Edition) The management of the acute ischemic priapism: A state of the art review
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Vol. 41. Issue 10.
Pages 607-613 (December 2017)
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Vol. 41. Issue 10.
Pages 607-613 (December 2017)
Review article
The management of the acute ischemic priapism: A state of the art review
El manejo del priapismo isquémico agudo: una revisión actualizada
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8
M. Falconea,b,
Corresponding author
mfalcone@unito.it

Corresponding author.
, A. Gilloc, M. Capecea,d, A. Raheema,e, D. Ralpha, G. Garaffaa
a St. Peter's Andrology and The Institute of Urology, University College of London Hospital (UCLH), Londres, United Kingdom
b Department of Urology, University of Turin, Città della Salute e della Scienza, Turín, Italy
c Department of Urology, Umberto Parini Hospital, Aosta, Italy
d Department of Urology, University of Naples, Naples, Italy
e Department of Andrology, University of Cairo, Cairo, Egypt
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Table 1. Up to date international series on early penile prosthesis implantation.
Table 2. The surgical and functional outcome of international series.
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Abstract
Objective

To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism (IP).

Acquisition of evidence

A systematic search for the terms “penile prosthesis”, “priapism”, “impotence”, “fibrosis”, “downsized prosthesis cylinders”, and “patient satisfaction” has been carried out in PubMed, EMBASE, Cochrane, SCOPUS and Science Citation Index databases.

Synthesis of evidence

Cavernosal tissue damage in IP is time related. Conservative measures and aspiration with or without intracorporeal instillation of α-adrenergic agonists are usually successful in the early stages. Shunt surgery in patients remains debatable, as the lack of response to aspiration and instillation of α-adrenergic agonists indicates that irreversible changes in the cavernosal smooth muscle are likely to have already occurred. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening.

Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient's satisfaction following surgery.

Keywords:
Priapism
Penile prosthesis
Fibrosis
Erectile dysfunction
Resumen
Objetivo

Revisar la literatura actual sobre implantación de prótesis peneana temprana en pacientes con priapismo isquémico (PI) refractario.

Adquisición de la evidencia

Se ha realizado una búsqueda sistemática de los términos «prótesis peneana», «priapismo», «impotencia», «fibrosis», «cilindros de prótesis reducidos» y «satisfacción del paciente» en bases de datos PubMed, EMBASE, Cochrane, SCOPUS y Science Citation Index.

Síntesis de la evidencia

El daño del tejido cavernoso en PI está relacionado con el tiempo. Las medidas conservadoras y la aspiración con o sin instilación intracorpórea de agonistas α-adrenérgicos suelen tener éxito en las primeras etapas. La cirugía de derivación en pacientes sigue siendo discutible, ya que la falta de respuesta a la aspiración y a la instilación de agonistas α-adrenérgicos indica que es probable que ya hayan ocurrido cambios irreversibles en el músculo liso cavernoso. La implantación inmediata de la prótesis peneana en pacientes con PI refractario soluciona el episodio fálico, mantiene la rigidez a largo plazo necesaria para participar en relaciones sexuales penetrativas y previene el acortamiento peneano inevitable de otra manera.

Aunque las tasas de complicaciones después de la implantación de la prótesis peneana en el priapismo agudo son mayores que en los casos virginales, son aún más bajas que después de la implantación en pacientes con fibrosis corporal grave debida al priapismo crónico. Independientemente de las tasas de complicaciones, la implantación de prótesis peneana en PI refractario debe ser preferida, ya que permite la preservación de la longitud del pene, que es uno de los principales factores que influyen en la satisfacción del paciente postoperatorio después de la cirugía.

Palabras clave:
Priapismo
Prótesis peniana
Fibrosis
Disfunción eréctil

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