Research on Priapism Published in IJIR: Your Sexual Medicine Journal
As a specialist in men's health, I'm committed to providing the best possible care for all urological emergencies. Among the most urgent is Ischaemic Priapism (IP)—a painful, prolonged erection lasting over four hours, unrelated to sexual stimulation. IP is a true urological emergency that, if not managed promptly, can lead to permanent Erectile Dysfunction (ED) and severe penile deformity.
My colleagues and I recently published a narrative review, "Early penile prosthesis implantation in refractory ischaemic priapism," that addresses a critical shift in how we manage the most severe cases: Refractory Ischaemic Priapism (RIP). Defined as IP persisting beyond 48 hours despite initial conservative treatments (like aspiration, corporal washout, or intracavernosal sympathomimetics), RIP demands a proactive surgical strategy.
About the Publication and What It Means for You
The review, published in the prestigious international journal IJIR: Your Sexual Medicine Journal synthesised the current evidence to evaluate the outcomes of placing a penile prosthesis (PP) implant early versus delaying the procedure.
The Critical Problem: Time is Tissue
Our research highlights why time is the critical factor in managing this condition.
Irreversible Damage: IP leads to progressive hypoxia and ischaemia, causing time-dependent corporal smooth muscle (CSM) damage. After about 48 hours, this progresses to diffuse sinusoidal thrombosis, CSM cell necrosis, and the development of penile fibrosis (scarring). This means that even if the erection is successfully reversed, recovery of natural erectile function is unlikely.
Complications of Delayed Surgery: If the implant surgery is delayed (performed into fibrotic corpora), the operation can become significantly more complex. In these cases, the surgeon must work through dense, almost concrete-like scar tissue to create space for the prosthetic cylinders. This leads to significantly higher risks.
The Solution: The Superiority of Early Intervention
Our findings strongly support early PP implantation—which we defined as within the <48-hour timeframe—as the preferred management strategy for RIP.
The benefits of early intervention are clear and directly impact patient well-being and surgical success:
| Outcome | Early (%) [168] | Delayed (%) [168] |
|---|---|---|
| Patient Satisfaction | 93.9% [168] | 60% [168] |
| Complaint of Penile Shortening | 1.7% [168] | 36.4% [168] |
| Revision Rate | 9.8% [168] | 23.7% [168] |
| Overall Intra-op Complication Rate | 1% [168] | 18.5% [168] |
Preserving Function and Form: The early placement of the prosthesis acts as a static tissue expander, effectively preventing the morphological changes (shortening and deformity) caused by progressive scarring.
What This Means for Our Practice
This publication confirms our surgical philosophy:
Proactive Management: For patients presenting with RIP, especially those with IP duration >48 hours, early PP implantation should be considered.
Using Diagnostics to Guide Care: We can use advanced diagnostics, like Magnetic Resonance Imaging (MRI), which has a high sensitivity for demonstrating irreversible CSM necrosis or fibrosis, to guide the urgent need for early.
Risk Mitigation: While early insertion has reduced risks, the review outlines essential risk mitigation strategies. For instance, if a distal shunting procedure was attempted first, a slight deferral (up to 3 weeks) may be favourable to allow swelling resolution and healing, thus reducing the risk of later implant erosion.
We are proud to have contributed this evidence to the global urological community, reinforcing that when it comes to RIP, acting early is the best way to secure the best possible long-term functional outcome for our patients.
Book a Consultation
If you or a loved one are facing a complex urological issue, or if you are seeking a specialist opinion on the surgical management of erectile dysfunction or priapism, Dr Ross is here to help.
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We look forward to providing you with personalised, evidence-based care informed by the latest research, including this work.