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.
Evangelos
E
Zacharakis
Gulio
G
Garaffa
Amr A
AA
Raheem
Andrew N
AN
Christopher
Asif
A
Muneer
David J
DJ
Ralph
D000328:Adult; D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019935:Penile Implantation; D015917:Penile Prosthesis; D010413:Penis / Q000098:blood supply*; D011317:Priapism / Q000209:etiology / Q000628:therapy*; D020127:Recovery of Function; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome