Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation.

Objective: To compare the long-term results of early and delayed insertion of a penile prosthesis (PP) in men with refractory ischaemic priapism (IP).

Methods: Early insertion of a PP was carried out in 68 men with IP within a median of 7 days from the onset of priapism, while 27 had delayed insertion after a median of 5 months. The results for sexual ability, satisfaction and subjective penile shortening were assessed by questioning at follow-up visits.

Results: In the early group, a malleable and an inflatable PP were implanted in 64 and four patients, respectively. After a median follow-up of 17 months, six patients needed revision surgery due to infection and curvature. Patient's satisfaction rate and ability to have sexual intercourse was 96%. In the delayed group, a malleable PP was inserted in 12 patients and an inflatable in the remaining 15. In all, 80% of the patients required a second corporotomy and downsized cylinders due to dense fibrosis. After a median follow-up of 21 months,seven patients required revision surgery due to infection,erosion and mechanical failure. In all, 25 patients were able to engage in sexual intercourse but the satisfaction rate was only 60% mainly due to significant penile shortening.

Conclusions: Early PP implantation should be the preferred option inpatients with IP, as the procedure is technically easier, has less complication rates and allows greater preservation of penile length.