Management of Prolonged Ischemic Priapism: A Case Series and Critical Analysis of Early Penile Prosthesis Implantation

Introduction: Priapism is a condition characterized by prolonged erections lasting longer than 4 h, classified as ischemic and nonischemic. This case series is aimed at reporting the therapeutic approaches employed and the outcomes observed in patients with prolonged priapism. Cases Description: We reported seven consecutive cases of prolonged priapism managed by the authors. Collected data included duration of priapism, interventions performed, and posttreatment outcomes. In Cases 1 and 2, drainage procedures and shunts were ineffective, resulting in erectile dysfunction. Cases 3 and 4 involved the implantation of semirigid prostheses after 6 and 40 days. In Case 5, an infectious complication occurred following prosthesis implantation in a patient with previous distal shunts. Case 6 demonstrated a patient with priapism had success with early prosthesis implantation. Case 7 described a patient with cocaine-induced priapism received a prosthesis on the sixth day. Discussion: The management of ischemic priapism directly depends on the time elapsed since the onset of symptoms. After 48 h, necrosis of the corpora cavernosa becomes inevitable, and surgical shunt procedures show limited efficacy. Early implantation of penile prostheses is an effective strategy to avoid late complications such as penile fibrosis. However, the decision must consider risks such as infection and prosthesis extrusion. Shunt procedures prior to penile implantation should be indicated with caution. Conclusion: The implantation of penile prostheses is a safe and effective therapeutic option for prolonged priapism. Excessive surgical manipulation of the penis with attempts at cavernous shunting in these cases often provides no benefit and may increase the risk of prosthesis infectious complications.