PL 01. Al-Ghorab Shunt plus intracavernous tunneling for prolonged ischemic priapism

Priapism is a pathological state of penile erection, which has been defined as persistent penile erection more than 4 hours without relationship with sexual stimulation. In general, the penile erected duration of more than 4 hours could be diagnosed as priapism and which could be classified in three types of non-ischemic priapism (NIP), ischemic priapism (IP), and recurrent or stuttering priapism. IP is the penile detumescence disorder and the main hemodynamic changes of IP are corpus cavernosm (CC) vein drainage dysfunction initially followed by the CC arterial perfusion dysfunction secondly and significantly increased CC pressure. Pathophysiological changes in CC of persistence IP is associated with increasing anoxia, arising of CO2 and acidosis, until corpus cavernosm tissue necrosis and fibrosis and the clinical symptoms of IP showed that severe painful hardness erection due to ischemic and necrosis in CC and percutaneous swelling and infection and these changes could be detected by CC aspiration, gas analysis and untrasonography. The goal for management of IP should be to quickly reduce intracavernosal pressure to restore venous drainage for penile detumescence, establish arterial perfusion of CC to relieve the hypoxia state of CC to prevent structural damage and fibrosis and to preserve erectile function.

At present, the suggested methods for treating IP are phenyllepherine intracavernous injection therapy and CC aspiration using 19G butterfly needle firstly, which might be effective for ischemic priapism less than 12 hours, if such a therapy failed cases or prolonged ischemic priapism(PIP), the shunt procedure such as corpus cavernosum-corpus spongiosum shunt (CC-CSS) including T-shaped shunt of CC and corpus spongiosum is recommended, the advantage of this procedure is that the simple operation can be carried out under local anesthesia and can quickly set up a shunt. However, our previous experience of CC-CSS distal shunt on PIP showed often failure, because such a surgery was difficult in establishing proximal corpus cavernosal arterial blood perfusion due to hypoxia induced CC tissue severe edema in patient with PIP over than 48 hours.

Our recent study to investigate the efficacy and safety of corpus cavernosum-corpus spongiosum shunt (Al-Ghorab Shunt) plus intracavernous tunneling (CC-CSS+ICT) for prolonged ischemic priapism (PIP) showed that the CCCSS+ ICT could quickly reduce penile rigidity and pain for improving the symptoms of PIP and suggested a safe and effective therapeutic method for PIP.