Management challenges in ischemic priapism – a case series

Author: 
Periasamy P, Senthilvel A and Asha Valantine L

Objective: The aim of this presentation is to review the current management options and to analyse the various management challenges and outcomes of priapism.
Methods: This is a case series of 6cases of priapism who presented to our Urology department, Kilpauk Medical College Hospital & Govt Royapettah Hospital during the period of 1 year 6months from January 2017 to June 2018. 2 among 6 cases, presented within 6 hours and were successfully managed conservatively. 2 cases underwent Glanular T shunt. All cases were managed in a stepwise manner, first by penile aspiration followed by intracavernosal injection of phenylephrine which was repeated several times. Surgical correction was done in 4 cases. Distal corpora glanular T shunt was performed first. It failed in 2 patients which were managed with venous bypass by Gray Hack (sapheno-cavernosal) shunt. Postoperatively patients were given anticoagulants for 5 days along with pentoxifylline 400mg tds.
Results: 2 cases who presented early were successfully managed conservatively without the need for surgical intervention. There was no reported incidence of erectile dysfunction in these cases. In those patients (4) who presented late and had surgical intervention, pain relief was achieved & varying degrees of erectile dysfunction was present.
Conclusion: The management of ischemic priapism is to achieve normal penis and normal erection. Time duration between onset and presentation and the timing of surgical intervention were the two most important predictors of successful outcome in the management of priapism

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DOI: 
http://dx.doi.org/10.24327/ijcar.2019.3881.19955
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