World J Mens Health.  2018 Jan;36(1):4-14. 10.5534/wjmh.17040.

Role of Penile Prosthesis in Priapism: A Review

• Reddy AG
• Alzweri LM
• Gabrielson AT
• Leinwand G
• Hellstrom

• KMID: 2399167
• DOI: http://doi.org/10.5534/wjmh.17040

Abstract

Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.

Keyword

Erectile dysfunction; Priapism; Prostheses and implants

MeSH Terms

Consensus
Emergencies
Erectile Dysfunction
Expert Testimony
Fibrosis
Humans
Joints
Male
Penile Implantation
Penile Prosthesis*
Priapism*
Prostheses and Implants
Psychological Trauma
Retrospective Studies

Figure

• 

  Fig. 1 Comparing intracavernosal arterial blood gas measurements obtained in ischemic priapism, non-ischemic priapism, and the normal flaccid penis.

Reference

1. Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. American Urological Association guideline on the management of priapism. J Urol. 2003; 170:1318–1324. PMID: 14501756.

2. Eland IA, van der Lei J, Stricker BH, Sturkenboom MJ. Incidence of priapism in the general population. Urology. 2001; 57:970–972. PMID: 11337305.

3. Cherian J, Rao AR, Thwaini A, Kapasi F, Shergill IS, Samman R. Medical and surgical management of priapism. Postgrad Med J. 2006; 82:89–94. PMID: 16461470.

4. Anele UA, Le BV, Resar LM, Burnett AL. How I treat priapism. Blood. 2015; 125:3551–3558. PMID: 25810489.

5. Kadioglu A, Sanli O, Celtik M, Cakan M, Taskapu H, Akman T. Practical management of patients with priapism. EAU-EBU Update Ser. 2006; 4:150–160.

6. Parivar F, Lue TF. Priapism. In : Hellstrom WJG, editor. Male infertility and sexual dysfunction. New York: Springer;1997. p. 401–408.

7. Podolej GS, Babcock C. Emergency department management of priapism. Emerg Med Pract. 2017; 19:1–16.

8. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, Shamloul R. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010; 7:476–500. PMID: 20092449.

9. Zheng DC, Yao HJ, Zhang K, Xu MX, Chen Q, Chen YB, et al. Unsatisfactory outcomes of prolonged ischemic priapism without early surgical shunts: our clinical experience and a review of the literature. Asian J Androl. 2013; 15:75–78. PMID: 22922321.

10. Salonia A, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Vardi Y, et al. European Association of Urology guidelines on priapism. Eur Urol. 2014; 65:480–489. PMID: 24314827.

11. Canguven O, Cetinel C, Horuz R, Tarhan F, Hamarat B, Goktas C. Transient distal penile corporoglanular shunt as an adjunct to aspiration and irrigation procedures in the treatment of early ischemic priapism. Korean J Urol. 2013; 54:394–398. PMID: 23789049.

12. Keskin D, Cal C, Delibaş M, Ozyurt C, Günaydin G, Nazli O, et al. Intracavernosal adrenalin injection in priapism. Int J Impot Res. 2000; 12:312–314. PMID: 11416834.

13. McDonald M, Santucci RA. Successful management of stuttering priapism using home self-injections of the alpha-agonist metaraminol. Int Braz J Urol. 2004; 30:121–122. PMID: 15703094.

14. Ahmed I, Shaikh NA. Treatment of intermittent idiopathic priapism with oral terbutaline. Br J Urol. 1997; 80:341. PMID: 9284216.

15. Ridgley J, Raison N, Sheikh MI, Dasgupta P, Khan MS, Ahmed K. Ischaemic priapism: a clinical review. Turk J Urol. 2017; 43:1–8. PMID: 28270944.

16. Zacharakis E, Raheem AA, Freeman A, Skolarikos A, Garaffa G, Christopher AN, et al. The efficacy of the T-shunt procedure and intracavernous tunneling (snake maneuver) for refractory ischemic priapism. J Urol. 2014; 191:164–168. PMID: 23892191.

17. Burnett AL, Pierorazio PM. Corporal “snake” maneuver: corporoglanular shunt surgical modification for ischemic priapism. J Sex Med. 2009; 6:1171–1176. PMID: 19207268.

18. Garcia MM, Shindel AW, Lue TF. T-shunt with or without tunnelling for prolonged ischaemic priapism. BJU Int. 2008; 102:1754–1764. PMID: 19035864.

19. Caraceni E, Marronaro A, Leone L. Salvage procedure in case of urethrocavernous fistula after revision surgery for malfunctioning three-piece penile prosthesis. Case Rep Urol. 2016; DOI: 10.1155/2016/4179862.

20. Hoeh MP, Levine LA. Prevention of recurrent ischemic priapism with ketoconazole: evolution of a treatment protocol and patient outcomes. J Sex Med. 2014; 11:197–204. PMID: 24433561.

21. Sandock DS, Seftel AD, Herbener TE, Goldstein I, Greenfield AJ. Perineal abscess after embolization for high-flow priapism. Urology. 1996; 48:308–311. PMID: 8753749.

22. Scott FB, Bradley WE, Timm GW. Management of erectile impotence. Use of implantable inflatable prosthesis. Urology. 1973; 2:80–82. PMID: 4766860.

23. Brindley GS. Cavernosal alpha-blockade: a new technique for investigating and treating erectile impotence. Br J Psychiatry. 1983; 143:332–337. PMID: 6626852.

24. Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group. N Engl J Med. 1998; 338:1397–1404. PMID: 9580646.

25. Ralph DJ, Garaffa G, Muneer A, Freeman A, Rees R, Christopher AN, et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur Urol. 2009; 56:1033–1038. PMID: 18930579.

26. Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013; 381:153–165. PMID: 23040455.

27. Chung E. Penile prosthesis implant: scientific advances and technological innovations over the last four decades. Transl Androl Urol. 2017; 6:37–45. PMID: 28217449.

28. Casabé AR, Sarotto N, Gutierrez C, Bechara AJ. Satisfaction assessment with malleable prosthetic implant of Spectra (AMS) and Genesis (Coloplast) models. Int J Impot Res. 2016; 28:228–233. PMID: 27557609.

29. Falcone M, Rolle L, Ceruti C, Timpano M, Sedigh O, Preto M, et al. Prospective analysis of the surgical outcomes and patients’ satisfaction rate after the AMS Spectra penile prosthesis implantation. Urology. 2013; 82:373–376. PMID: 23791218.

30. Dubocq F, Tefilli MV, Gheiler EL, Li H, Dhabuwala CB. Long-term mechanical reliability of multicomponent inflatable penile prosthesis: comparison of device survival. Urology. 1998; 52:277–281. PMID: 9697794.

31. Lux M, Reyes-Vallejo L, Morgentaler A, Levine LA. Outcomes and satisfaction rates for the redesigned 2-piece penile prosthesis. J Urol. 2007; 177:262–266. PMID: 17162061.

32. Levine LA, Estrada CR, Morgentaler A. Mechanical reliability and safety of, and patient satisfaction with the Ambicor inflatable penile prosthesis: results of a 2 center study. J Urol. 2001; 166:932–937. PMID: 11490249.

33. Kim DS, Yang KM, Chung HJ, Choi HM, Choi YD, Choi HK. AMS 700CX/CXM inflatable penile prosthesis has high mechanical reliability at long-term follow-up. J Sex Med. 2010; 7:2602–2607. PMID: 20384938.

34. Trost L, Wanzek P, Bailey G. A practical overview of considerations for penile prosthesis placement. Nat Rev Urol. 2016; 13:33–46. PMID: 26620609.

35. Montague DK, Jarow JP, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. Chapter 1: the management of erectile dysfunction: an AUA update. J Urol. 2005; 174:230–239. PMID: 15947645.

36. Nielsen KT, Bruskewitz RC. Semirigid and malleable rod penile prostheses. Urol Clin North Am. 1989; 16:13–23. PMID: 2916270.

37. Bozkurt IH, Arslan B, Yonguc T, Kozacıoglu Z, Degirmenci T, Gunlusoy B, et al. Patient and partner outcome of inflatable and semi-rigid penile prosthesis in a single institution. Int Braz J Urol. 2015; 41:535–541. PMID: 26200547.

38. Song WD, Yuan YM, Cui WS, Wu AK, Zhu YC, Liu J, et al. Penile prosthesis implantation in Chinese patients with severe erectile dysfunction: 10-year experience. Asian J Androl. 2013; 15:658–661. PMID: 23872664.

39. Ji YS, Ko YH, Song PH, Moon KH. Long-term survival and patient satisfaction with inflatable penile prosthesis for the treatment of erectile dysfunction. Korean J Urol. 2015; 56:461–465. PMID: 26078844.

40. Serefoglu EC, Mandava SH, Gokce A, Chouhan JD, Wilson SK, Hellstrom WJ. Long-term revision rate due to infection in hydrophilic-coated inflatable penile prostheses: 11-year follow-up. J Sex Med. 2012; 9:2182–2186. PMID: 22759917.

41. Wilson SK, Henry GD, Delk JR Jr, Cleves MA. The mentor Alpha 1 penile prosthesis with reservoir lock-out valve: effective prevention of auto-inflation with improved capability for ectopic reservoir placement. J Urol. 2002; 168:1475–1478. PMID: 12352421.

42. Grewal S, Vetter J, Brandes SB, Strope SA. A population-based analysis of contemporary rates of reoperation for penile prosthesis procedures. Urology. 2014; 84:112–116. PMID: 24785986.

43. Rees RW, Kalsi J, Minhas S, Peters J, Kell P, Ralph DJ. The management of low-flow priapism with the immediate insertion of a penile prosthesis. BJU Int. 2002; 90:893–897. PMID: 12460352.

44. Bennett N, Mulhall J. Sickle cell disease status and outcomes of African-American men presenting with priapism. J Sex Med. 2008; 5:1244–1250. PMID: 18312286.

45. Pohl J, Pott B, Kleinhans G. Priapism: a three-phase concept of management according to aetiology and prognosis. Br J Urol. 1986; 58:113–118. PMID: 3516294.

46. Broderick GA, Harkaway R. Pharmacologic erection: time-dependent changes in the corporal environment. Int J Impot Res. 1994; 6:9–16. PMID: 8019618.

47. Sedigh O, Rolle L, Negro CL, Ceruti C, Timpano M, Galletto E, et al. Early insertion of inflatable prosthesis for intractable ischemic priapism: our experience and review of the literature. Int J Impot Res. 2011; 23:158–164. PMID: 21654814.

48. Pal DK, Biswal DK, Ghosh B. Outcome and erectile function following treatment of priapism: an institutional experience. Urol Ann. 2016; 8:46–50. PMID: 26834401.

49. Nixon RG, O'Connor JL, Milam DF. Efficacy of shunt surgery for refractory low flow priapism: a report on the incidence of failed detumescence and erectile dysfunction. J Urol. 2003; 170:883–886. PMID: 12913722.

50. Zacharakis E, Garaffa G, Raheem AA, Christopher AN, Muneer A, Ralph DJ. Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation. BJU Int. 2014; 114:576–581. PMID: 25383397.

51. Tausch TJ, Mauck R, Zhao LC, Morey AF. Penile prosthesis insertion for acute priapism. Urol Clin North Am. 2013; 40:421–425. PMID: 23905940.

52. Upadhyay J, Shekarriz B, Dhabuwala CB. Penile implant for intractable priapism associated with sickle cell disease. Urology. 1998; 51:638–639. PMID: 9586621.

53. Martínez-Salamanca JI, Mueller A, Moncada I, Carballido J, Mulhall JP. Penile prosthesis surgery in patients with corporal fibrosis: a state of the art review. J Sex Med. 2011; 8:1880–1889. PMID: 21492405.

54. Sansalone S, Garaffa G, Djinovic R, Antonini G, Vespasiani G, Ieria FP, et al. Simultaneous total corporal reconstruction and implantation of a penile prosthesis in patients with erectile dysfunction and severe fibrosis of the corpora cavernosa. J Sex Med. 2012; 9:1937–1944. PMID: 22672346.

55. Wilson SK, Delk JR 2nd, Mulcahy JJ, Cleves M, Salem EA. Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis. J Sex Med. 2006; 3:736–742. PMID: 16839331.

56. Wilson SK, Delk JR 2nd. Inflatable penile implant infection: predisposing factors and treatment suggestions. J Urol. 1995; 153:659–661. PMID: 7861509.

57. Salem EA, El Aasser O. Management of ischemic priapism by penile prosthesis insertion: prevention of distal erosion. J Urol. 2010; 183:2300–2303. PMID: 20400140.

58. Sukhu T, Carson CC, Coward RM. Distal extrusion and impending cylinder erosion of the penile prosthesis: a clinical challenge for the urologist. Curr Sex Health Rep. 2016; 8:86–90.

59. Durazi MH, Jalal AA. Penile prosthesis implantation for treatment of postpriapism erectile dysfunction. Urol J. 2008; 5:115–119. PMID: 18592465.

60. Shaeer O. Penile prosthesis implantation in cases of fibrosis: ultrasound-guided cavernotomy and sheathed trochar excavation. J Sex Med. 2007; 4:809–814. PMID: 17419815.

61. Montague DK, Angermeier KW, Lakin MM, Ingleright BJ. AMS 3-piece inflatable penile prosthesis implantation in men with Peyronie's disease: comparison of CX and Ultrex cylinders. J Urol. 1996; 156:1633–1635. PMID: 8863557.

62. Summerton DJ, Campbell A, Minhas S, Ralph DJ. Reconstructive surgery in penile trauma and cancer. Nat Clin Pract Urol. 2005; 2:391–397. PMID: 16474736.

63. Knoll LD, Furlow WL, Benson RC Jr, Bilhartz DL. Management of nondilatable cavernous fibrosis with the use of a downsized inflatable penile prosthesis. J Urol. 1995; 153:366–367. PMID: 7815585.

64. Tsambarlis PN, Chaus F, Levine LA. Successful placement of penile prostheses in men with severe corporal fibrosis following vacuum therapy protocol. J Sex Med. 2017; 14:44–46. PMID: 27938991.

65. Abaunza H, Romero K. Elements for adequate informed consent in the surgical context. World J Surg. 2014; 38:1594–1604. PMID: 24803343.