TY - JOUR
T1 - Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism
T2 - a systematic review by the EAU Sexual and Reproductive Health Guidelines panel
AU - Milenkovic, U.
AU - Cocci, A.
AU - Veeratterapillay, R.
AU - Dimitropoulos, K.
AU - Boeri, L.
AU - Capogrosso, P.
AU - Cilesiz, N. C.
AU - Gul, M.
AU - Hatzichristodoulou, G.
AU - Modgil, V.
AU - Russo, G. I.
AU - Tharakan, T.
AU - Omar, M. I.
AU - Bettocchi, C.
AU - Carvalho, J.
AU - Yuhong, Y.
AU - Corona, G.
AU - Jones, H.
AU - Kadioglu, A.
AU - Martinez-Salamanca, J. I.
AU - Verze, P.
AU - Serefoglu, E. C.
AU - Minhas, S.
AU - Salonia, A.
N1 - © 2022. The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2022/9/23
Y1 - 2022/9/23
N2 - Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an arterial fistula and embolisation may be required. We conducted a systematic review on behalf of the EAU Sexual and Reproductive health Guidelines panel to analyse the available evidence on efficacy and safety of surgical modalities for IP and NIP. Outcomes were priapism resolution, sexual function and adverse events following surgery. Overall, 63 studies (n = 923) met inclusion criteria up to September 2021. For IP (n = 702), surgery comprised distal (n = 274), proximal shunts (n = 209) and penile prostheses (n = 194). Resolution occurred in 18.7-100% for distal, 5.7–100% for proximal shunts and 100% for penile prostheses. Potency rate was 20–100% for distal, 11.1–77.2% for proximal shunts, and 26.3–100% for penile prostheses, respectively. Patient satisfaction was 60–100% following penile prostheses implantation. Complications were 0–42.5% for shunts and 0–13.6% for IPP. For NIP (n = 221), embolisation success was 85.7–100% and potency 80–100%. The majority of studies were retrospective cohort studies. Risk of bias was high. Overall, surgical shunts have acceptable success rates in IP. Proximal/venous shunts should be abandoned due to morbidity/ED rates. In IP > 48 h, best outcomes are seen with penile prostheses implantation. Embolisation is the mainstay technique for NIP with high resolution rates and adequate erectile function.
AB - Surgical treatments for ischemic priapism (IP) include shunts or penile implants. Non-ischemic priapism (NIP) is usually the result of penile/perineal trauma causing an arterial fistula and embolisation may be required. We conducted a systematic review on behalf of the EAU Sexual and Reproductive health Guidelines panel to analyse the available evidence on efficacy and safety of surgical modalities for IP and NIP. Outcomes were priapism resolution, sexual function and adverse events following surgery. Overall, 63 studies (n = 923) met inclusion criteria up to September 2021. For IP (n = 702), surgery comprised distal (n = 274), proximal shunts (n = 209) and penile prostheses (n = 194). Resolution occurred in 18.7-100% for distal, 5.7–100% for proximal shunts and 100% for penile prostheses. Potency rate was 20–100% for distal, 11.1–77.2% for proximal shunts, and 26.3–100% for penile prostheses, respectively. Patient satisfaction was 60–100% following penile prostheses implantation. Complications were 0–42.5% for shunts and 0–13.6% for IPP. For NIP (n = 221), embolisation success was 85.7–100% and potency 80–100%. The majority of studies were retrospective cohort studies. Risk of bias was high. Overall, surgical shunts have acceptable success rates in IP. Proximal/venous shunts should be abandoned due to morbidity/ED rates. In IP > 48 h, best outcomes are seen with penile prostheses implantation. Embolisation is the mainstay technique for NIP with high resolution rates and adequate erectile function.
KW - Humans
KW - Male
KW - Penile Erection
KW - Penile Prosthesis/adverse effects
KW - Penis/surgery
KW - Priapism/etiology
KW - Reproductive Health
KW - Retrospective Studies
UR - http://www.scopus.com/inward/record.url?scp=85138743216&partnerID=8YFLogxK
U2 - 10.1038/s41443-022-00604-1
DO - 10.1038/s41443-022-00604-1
M3 - Article
C2 - 36151318
AN - SCOPUS:85138743216
SN - 0955-9930
VL - 36
SP - 36
EP - 49
JO - International Journal of Impotence Research
JF - International Journal of Impotence Research
IS - 1
ER -