title: Efficacy of shunt surgery for refractory low flow priapism: a report on the incidence of failed detumescence and erectile dysfunction.
abstract: OBJECTIVE
  The reported success rate for surgical cavernosa-to-spongiosum shunts in patients with refractory low flow priapism is variable and yet it is reported to be as high as 100% in terms of achieving detumescence. The long-term potency rate after the introduction of the shunt procedure is also as high as 50%. We reviewed the efficacy of various shunts in terms of achieving detumescence and we clarified the rate of erectile dysfunction at long-term followup.
  
  
  METHODS
  Patients were included in the analysis if they had painful low flow priapism more than 4 hours in duration that was refractory to conservative management, ultimately requiring a surgical shunt. Data, including etiology, duration and initial treatment measures, were retrospectively compiled in the last 12 years and the type of surgical shunts performed were recorded. Followup erectile function was assessed by clinical notes and a telephone survey using the International Index of Erectile Function.
  
  
  RESULTS
  Of the 28 consecutive patients included in the study 13 (46.4%) required more than 1 operation for failed detumesence, of whom 12 (92.3%) initially underwent a Winter shunt. Only 2 of the 20 men (10%) with available followup reported preservation of pre-morbid erectile function. Three men (15%) achieved partial erection without the assistance of oral or injectable agents.
  
  
  CONCLUSIONS
  In contrast to previously reported success rates, approximately 50% of our patients required reoperation for failed detumescence following a cavernosa-to-spongiosum shunt. In our experience the Winter shunt was the least successful operation, whereas reoperation was uncommonly required following an Al-Ghorab or Quackels shunt. As many as 90% of our patients had erectile dysfunction at followup.
authors.affiliation: Department of Urologic Surgery, Vanderbilt University School of Medicine, Medical Center North, Nashville, TN 37232, USA.
authors.forename: Randy G
authors.initials: RG
authors.lastname: Nixon
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: O'Connor
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Milam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D007172:Erectile Dysfunction / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011317:Priapism / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects