Our expert says:
Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction.
It can occur in all age groups, including newborns. However, it usually affects boys between the ages of 5-10 years and men between the ages of 20-50 years.
There are two categories of priapism: low-flow and high-flow.
·Low-flow: This type of priapism is the result of blood being trapped in the erection chambers. It often occurs without a known cause in men who are otherwise healthy, but also affects men with sickle-cell disease, leukemia (cancer of the blood), or malaria.
·High-flow: High-flow priapism is more rare than low-flow and usually less painful. It is the result of a ruptured artery from an injury to the penis or the perineum (area between the scrotum and anus), which prevents blood in the penis from circulating normally.
A priapism shunt used for low-flow priapism, is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.
Following failure of conservative management and injection therapy, surgical shunting is advised. This is accomplished with either a minimally invasive shunt (such as a Winter technique, performed with a large-bore biopsy needle) or a more invasive operative shunt (the Ebbehoj or Al-Ghorab procedure). While the Winter procedure is performed at the bedside, operative shunts require from 45 minutes to 1 hour of theatre time.
Complications of surgical therapy include bleeding, infection, urethral injury, hematoma formation, and ED. The rates of ED following medical and/or surgical shunting have been poorly reported, but are estimated to be approximately 25%, with rates as high as 90% in some studies
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