Penile Implant Insertion in Post Priapism; the Indications, Procedure, Limitations and Complications.

Abstract Background Priapism is a clinical state in which there is persistent usually painful penile erection often in the absence of erotic psychic stimuli or fails to subside despite orgasm. This is a urological emergency which may cause damage to the corporal tissue and ED. Method This was a combined retrospective and prospective study to determine patient presentation and the indications,surgical procedure, limitations and complications of penile implant insertions in patients who presented with priapism sequelae. The subjects were all consenting patients who presented to our hospital with priapism sequelae and who had initial management of the priapism (in our hospital or elsewhere) and eventually had insertion of malleable penile implant in our hospital from January 2017 to June 2024. The records of all the information on the patients was retrieved (and recorded) from our register/electronic records for those included retrospectively while those included prospectively, records were taken as at the time of treatment. Results A total of 46 patients were recruited into the study with 14 of them presented in refractory priapism and the 32 presented with corporal fibrosis following poorly treated priapism. The patients were distributed into the 2 groups above and parameters calculated differently to explore any advantage in management of one group over the other. The age distributions differ with the refractory priapism group having a mean age of 24±3.6 years and the corporal fibrosis group of 37±9.7 years (t= -4.85, p= 0.00002). Sickle cell disease was the predominant cause of Priapism (69.6%). On initial presentation, majority (73.9%) had acute ischemic priapism while the remaining 27.1% had stuttering priapism. The intra-operative findings were that of dark blood with necrotic tissues in the refractory priapism group (21.7%) and varying degree of fibrosis in the corporal fibrosis group (69.6%). The duration of the surgery, length and diameter of the implant differ in the 2 groups with a p-value of <0.00001, 0.0018, <0.00001 respectively. Complications recorded include surgical site infection (17.4%), corporal perforation (6.5%) and implant infection (4.3%). Erectile function improved with IIEF score of 25-30 in 95.6% of our patients. Conclusion Penile implant insertion in both refractory priapism and corporal fibrosis is effective and safe procedure for the prevention or treatment of ED. A satisfactory sexual function and few or no complications are achieved if standard peri-operative procedures are followed.