title: Early insertion of a malleable penile prosthesis in ischaemic priapism allows later upsizing of the cylinders.
abstract: OBJECTIVE
  Early insertion of a penile prosthesis in prolonged ischaemic priapism is easier to perform than late prosthesis placement, and preserves the penile length. The aim of this study was to assess whether a delayed exchange to an inflatable implant allows upsizing of the cylinders in patients who have undergone early insertion for refractory ischaemic priapism.
  
  
  METHODS
  Over a 30 month period, 10 patients with ischaemic priapism underwent an early insertion of a malleable penile prosthesis. The mean age was 41.3 years and the mean duration of priapism was 188 h. Following a median period of 130.5 days, all of these patients underwent exchange of the malleable to an inflatable prosthesis.
  
  
  RESULTS
  At the time of penile implant exchange, a median upsize in the length of the cylinders of 1 cm in either one or both corporal bodies (range 0-3 cm) was recorded. Five patients had deliberate downsizing at the initial operation owing to a previous shunt. The mean score on the five-item International Index of Erectile Function (IIEF-5) before insertion of the malleable prosthesis was 24 (range 20-25). Three months after the initial insertion of a malleable penile implant the satisfaction rate according to the IIEF-5 score was 80%. Three months after the exchange, the patient satisfaction rate increased to 90%.
  
  
  CONCLUSIONS
  Insertion of a malleable penile prosthesis is an acceptable option for patients with refractory ischaemic priapism. Although some patients deliberately have a shorter implant inserted initially owing to a previous distal shunt procedure, following a period of resolution the cylinders can be upsized at a later operation.
authors.affiliation: a 1 Department of Urology, Guy's Hospital, King's College London , London, UK.|b 2 Department of Urology, University College London Hospitals , London, UK.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Zacharakis
authors.affiliation: a 1 Department of Urology, Guy's Hospital, King's College London , London, UK.|b 2 Department of Urology, University College London Hospitals , London, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: De Luca
authors.affiliation: b 2 Department of Urology, University College London Hospitals , London, UK.
authors.forename: Amr Abdul
authors.initials: AA
authors.lastname: Raheem
authors.affiliation: b 2 Department of Urology, University College London Hospitals , London, UK.
authors.forename: Giulio
authors.initials: G
authors.lastname: Garaffa
authors.affiliation: b 2 Department of Urology, University College London Hospitals , London, UK.
authors.forename: Nim
authors.initials: N
authors.lastname: Christopher
authors.affiliation: b 2 Department of Urology, University College London Hospitals , London, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Muneer
authors.affiliation: b 2 Department of Urology, University College London Hospitals , London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ralph
keywords: Cylinder upsizing; erectile dysfunction; ischaemic priapism; penile implant