Priapism is a long-lasting (>4 hours), unwanted erection that is not related to sexual stimulation. There are two types of priapism: low-flow (ischemic) priapism and high-flow (non-ischemic) priapism. Ischemic priapism is caused by a situation in which blood is unable to leave the penis, while non-ischemic priapism is generally caused by injury to an artery that may increase blood flow to the penis.
Ischemic priapism can cause damage to the smooth muscles of the penis and penile scarring/fibrosis if left untreated for an extended period of time. Such damage to the penis can cause permanent erectile dysfunction (ED), so it is important for an individual who is experiencing priapism to seek immediate medical attention from a qualified male sexual health expert.
ED is common in cases of priapism that last 36 to 48 hours. In the event that ED does occur and is not responsive to standard therapies, the typical treatment is inflatable penile prosthesis (IPP) placement. An IPP is a device containing two inflatable cylinders and a fluid reservoir that is surgically inserted into the penis and scrotum. It allows individuals to have on-demand erections by using a pump to fill the inflatable cylinders with fluid, then using the release valve to deflate the implant and return the penis to a flaccid state.
The timing of IPP placement after ischemic priapism may be important when it comes to IPP complication rates. When fibrosis and corporal scarring occur in the penis, it can become more difficult to place an IPP. As such, researchers recently investigated the impact of the timing of IPP placement on complications in men with a history of ischemic priapism.
A total of 124 patients who underwent IPP placement for ED were recruited from multiple medical centers for this study. Half of the men (62) had a history of priapism, and the other half (62) did not have a history of priapism. The men with a history of priapism were matched on a 1:1 ratio with the control subjects.
For the purposes of this study, early IPP placement was defined as less than 6 months after priapism, and delayed IPP placement was defined as more than 6 months after priapism. Fifteen of the men with a history of priapism had early IPP placement, and the remaining 47 had delayed IPP placement.
The authors found that 40.5% of the men who underwent delayed IPP placement following priapism experienced complications compared to 0% of the men who underwent early IPP placement after priapism. This finding suggests that delayed IPP placement after priapism may be associated with more complications than early placement. Nevertheless, there were some limitations of this study including the fact that very few participants were able to get an early IPP placement and the study itself was retrospective.
Despite these limitations, this study emphasizes the importance of timely intervention in patients with priapism to prevent future complications and improve outcomes related to IPP placement.
For more information on this topic, please read these publications from the ISSM Journals: The Journal of Sexual Medicine, Sexual Medicine Reviews, and Sexual Medicine Open Access:
Penile Prosthesis Implantation in Priapism
References:
- Barham, D.W., Chang, C., Hammad, M., Pyrgidis, N., Swerdloff, D., Gross, K., Hatzichristodoulou, G., Hsieh, T.C., Hotaling, J.M., Jenkins, L.C., & Jones, J.M. (2023). Delayed placement of an inflatable penile prosthesis is associated with a high complication rate in men with a history of ischemic priapism. The Journal of Sexual Medicine, 20(7), 1052-1056. https://doi.org/10.1093/jsxmed/qdad075
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