(244) Penoscrotal Decompression: A New Paradigm for Managing Prolonged Ischemic Priapism

Abstract Introduction Outcomes of men with delayed presentation ischemic priapism (>24 hours) are poor. Management options include forming a proximal corporal shunt (poor evidence efficacy) or immediate penile prosthesis placement the associated increased risk erosion and infection. Penoscrotal decompression (PSD) is thought to relieve acute compartment syndrome prolonged (PIP) restores perfusion. Experience currently limited 31 reported cases from several centers in North America. Objective To further assess role efficacy PSD for PIP. Methods Retrospective review presenting priapism. Only following were included. Ischemic was confirmed by cavernosal blood gas biopsy at time decompression. Duration ischemia, prior management clinical outcomes analyzed. Change International Index Erectile Function (IIEF) score compared. Results Thirteen patients median age 45 years (IQR 37-43) presented between July 2019 June 2022. Median duration PIP 48 hours 38-56). Etiology idiopathic 5, iatrogenic recreational drug-related 6 sickle-cell disease (SCD) 2 men. All failed aspiration, irrigation intracavernosal phenylephrine distal corporo-glanular shunting (T-shunt Winter shunt). had successful detumescence 9 (69%) requiring bilateral PSD. Immediate pain relief achieved all but one man who very (120 where no fresh bleeding found despite He chronic SCD lost follow-up discharge. Another patient recurred within 24 unilateral successfully managed phenylephrine. without developed recurrence next day he proceeded insertion malleable on 2. There association IIEF scores fell 12 2.25-15.5) severe erectile dysfunction. Four have inserted complication (2x inflatable, 2x malleable) awaiting surgery (one cancelled due anesthetic concerns). Follow-up 17.6 months 1.3 – 19.7) 4 follow-up. One unhappy length prosthesis. Conclusions In first study outside America, relieved good most (n=12, 92%). Six refractory dysfunction while 3 recurrent (n=2) cocaine abuse (n=1). This suggests that lack factor failure an should be considered. averted need 54% considered as viable option Disclosure No