Abstract: PD25-10
Sources of Funding: none

Introduction

Ischemic priapism unresolved by medical therapy typically progresses to surgical management with a distal or proximal penile shunt. Due to the infrequent nature of these cases, little has been reported regarding complications. As other treatment options arise, such as immediate penile prosthesis placement for long standing ischemic priapism, it is important to consider the hospital stay and complication rates of the current standard of care.

Methods

A retrospective cross sectional analysis was performed using the National Surgical Quality Improvement Project (NSQIP) database. Cases of penile shunts were identified from 2006-2014 using the ICD-9 procedure codes 54435 for distal corporoglanular shunt, 54430 for corporospongiosal shunt, and 54420 for corporosaphenous shunt. Univariate analysis was performed to compare 30-day complication rates for the different types of shunts.

Results

A total of 104 patients underwent operative management for ischemic priapism, 58.7% of which were listed as emergent cases. Mean age was 44.6 ± 13 years. Of the entire sample, 31.7% underwent a corporoglanular shunt, 54.8% underwent a corporospongiosal shunt, and 13.4% underwent a corporosaphenous shunt. Length of stay was longer for corporospongiosal shunts (2.19±1.98) than corporoglanular (1.88±2) or corporosaphenous shunts (1.5±1.23). Post-operative complications occurred in 4.81% of the sample. The more common complications were urinary tract infection (1.9%) and blood transfusion (1.9%). Corporospongiosal shunts exhibited higher overall complications (7.02%), followed by corporoglanular (3.03%) and corporosaphenous shunts (0%). Reoperation occurred in 8.45% of proximal shunts, versus 3.03% of corporoglanular shunts. Reoperation was more common if the case was listed as emergent (9.84%).

Conclusions

Ischemic priapism unresponsive to medical therapy continues to be a challenging problem. It appears that though complication rates overall are low for both proximal and distal penile shunts, the reoperation rate is substantial for proximal penile shunts. This should be considered when determining whether to perform a proximal shunt versus placement of an immediate penile prosthesis.

Funding

none