T-shaped shunt and intracavernous tunneling for prolonged ischemic priapism.
OBJECTIVE
Conservative management of prolonged ischemic priapism is rarely effective. Interventions include corporal aspiration/irrigation, injection of vasoconstrictive agents or surgical procedures. We describe a technique that fulfills several important criteria in the surgical management of ischemic priapism in that immediate resolution of ischemic pain is achieved, a wide area, reliably patent shunt is created, the procedure is technically simple and it may be performed with the patient under a local anesthetic.


METHODS
We reviewed the records of 13 patients treated with the T-shunt for whom followup, including erectile function, was available.


RESULTS
Records were available for review for 13 men who underwent the T-shunt procedure from April 2006 to January 2008. In most cases priapism had lasted for more than 24 hours and previous irrigation/intracorporal administration of sympathomimetics had been unsuccessful. Of these 13 men 6 had undergone unsuccessful distal or proximal shunt procedures before presentation to our service. All procedures were performed using local anesthetic only. Cavernous blood flow was restored in all but 1 patient and another required a second procedure. T-shunts resulted in resolution of penile pain in all patients and all but 2 had recovery of erectile function.


CONCLUSIONS
The T-shunt technique results in immediate resolution of ischemic penile pain and rigidity. Ultrasonography confirms that blood flow is usually restored to the previously ischemic corpora cavernosa after the procedure. The T-shaped shunt is simple and reliable, and access also allows for proximal trans-shunt dilation. We observed surprisingly excellent recovery of erectile function. This procedure may facilitate recanalization of corporal circulation and could make proximal shunts obsolete.
Brant
William O
WO
Northstar Urology, Vail, Colorado.
Garcia
Maurice M
MM
Bella
Anthony J
AJ
Chi
Tom
T
Lue
Tom F
TF
D000328:Adult; D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation / Q000379:methods; D004867:Equipment Design; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply*; D011317:Priapism / Q000209:etiology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000295:instrumentation / Q000379:methods