Clinical Experience and Sexual Function Outcome of Patients With Priapism Treated With Penile Cavernosal-Dorsal Vein Shunt Using Saphenous Vein Graft

• Published in: Urology (Ridgewood, N.J.) N.J.), 2009-03, Vol.73 (3), p.556-561
• Main Authors: Chiou, Rei K, Aggarwal, Himanshu, Mues, Adam C, Chiou, Christopher R, Broughton, Fleur L
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arteriovenous Shunt, Surgical - methods; Biological and medical sciences; Gynecology. Andrology. Obstetrics; Humans; Male; Male genital diseases; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Non tumoral diseases; Penile Erection; Penis - blood supply; Penis - surgery; Priapism - surgery; Retrospective Studies; Saphenous Vein - transplantation; Treatment Outcome; Urologic Surgical Procedures, Male - methods; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2008.10.025

Objectives To assess the outcome of new penile cavernosal-dorsal vein shunt using a saphenous vein graft. Traditional surgeries for priapism have high failure rate and subsequent impotence. Methods We reviewed the medical records of, and administered a questionnaire and the International Index of Erectile Function to, 16 consecutive patients with priapism who had treated with the penile cavernosal-dorsal vein shunt from 1997 to 2007. Their age was 15-65 years. The duration of ischemic priapism was 32 hours to 8 days. Ten patients had previously undergone shunt surgery by other urologists. Of the 16 patients, 5 returned the questionnaires. Results Priapism resolved or was improved after surgery in all 16 patients. One patient was lost to follow-up. One pediatric patient was excluded from the analysis. One patient with nonischemic priapism continued to have sexual intercourse. Of the 13 adult patients with ischemic priapism and follow-up for ≤6.5 years, 3 patients had no erection, 1 had very little erection, and 9 (69%) had erection. Of the 9 patients with erections possible, six had had sexual intercourse (International Index of Erectile Function score 32-70) and 3 had not; 1 had a mental disorder, 1 was in prison, and for 1, the reason was unknown. After surgery, color Doppler ultrasound studies showed a patent shunt in all patients and restoration of cavernosal arterial flow in 12 of 13 patients studied. Conclusions A penile cavernosal-dorsal shunt appears effective for priapism. It resulted in priapism resolution even in patients who had experienced a previous failed cavernosal-glandular shunt or cavernosal-spongiosal shunt, with a high rate of sexual function preservation.