Refractory Ischemic Priapism Duration Predicts Surgery Results

If it lasts more than 48 hours, the T-shunt procedure usually fails.
If it lasts more than 48 hours, the T-shunt procedure usually fails.

The success of the T-shunt with intracavernous snake tunneling for refractory ischemic priapism depends on the duration of the priapism, according to researchers.

That is the conclusion of a British study of 45 men with prolonged ischemic priapism and underwent the procedure following an unsuccessful primary treatment. All patients whose priapism lasted less than 24 hours experienced resolution of the problem after the procedure compared with only 30% of patients with priapism of greater than 48 hours duration, a team led by David J. Ralph, MD, of University College Hospital London in the U.K., reported in The Journal of Urology (2014;191:164-168).

Despite favorable results in the patients with priapism of less than 24 hours duration, erectile dysfunction (ED) was present in half of them, according to the researchers. All of the men whose priapism lasted more than 48 hours had necrotic cavernous smooth muscle on biopsy and had severe ED requiring insertion of a penile prosthesis. Men with moderate or mild ED were managed with phosphodiesterase type 5 inhibitors.

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