Data support immediate penile implant placement for priapism

Key Points

Attendees of the 2012 AUA annual meeting can anticipate learning about studies of sexual dysfunction that may have a significant impact on treatment paradigms.

Among the practice-changing topics to be anticipated are discussions of the immediate placement of penile implants to preserve sexual function and reduce or prevent the long-term sequelae of ischemic priapism, evaluations of the potential of testosterone replacement therapy in men treated for prostate cancer, more detailed information on sexual function rates following prostatectomy procedures, and discussion of counterfeit phosphodiesterase type-5 inhibitors being marketed on the Internet.

Presentation of priapism low

"Ischemic priapism accounts for perhaps six in 100,000 emergency room visits. The average urologist may see one case every 5 years," Dr. Mulcahy told Urology Times.

The presentation is associated with sickle cell disease and certain malignancies, but most often the etiology is described as idiopathic, he says. A significant, though unknown, portion of idiopathic priapism may be associated with prolonged foreplay without ejaculation.

Nevertheless, ischemic priapism is a serious condition. If intervention fails to resolve priapism within 12 to 24 hours, tissue begins to die. Within 48 hours, the damage can become irreversible. Fibrosis appears and spontaneous erections become impossible.

"When this happens, the only thing that is going to work is placement of a penile implant. Oral medications will not work. Injections will not work," said Dr. Mulcahy. He anticipates that there will be AUA discussion of European studies demonstrating the efficacy of immediate placement of penile prostheses in patients with refractory ischemic priapism.

"This [immediate prostheses implantation] is a far more common practice in Europe than in the United States for a variety of reasons, not the least of which is that treating this sort of dysfunction tends to be a litigious issue. However, immediate placement of prostheses appears to preserve function and length, and results in a better quality of life outcome," Dr. Mulcahy said.