CODE: 16.2 - The case of long-lasting low-flow priapism treated by cavernospongiosum shunt of Sacher
Article published in Urologia Polska 2006/59/Suplement 1.

authors

Ireneusz Ostrowski, Janusz Ciechan, Tadeusz Palec

Oddział Urologii Szpitala Specjalistycznego w Puławach

summary

Introduction. Priapism is pathologic, lasting more than 4 to 6 hours, persistent and extended erection of the penis that does not retreat after the orgasm and ejaculation. There are two types of priapism: low-flow priapism (ischemic; resulting from blood deficiency) and high-flow priapism (nonischemic). Low-flow priapism occurs in the course of haematological diseases (sickle cell anaemia, leukaemia) and tumorous diseases as well as following the treatment by psychotropic and intracavernous drugs used in erectile disfunction. They are often idiopathic cases. Low-flow priapism requires urgent surgical intervention.

Objectives. Presentation of the case of a patient treated for long-lasting low-flow priapism by way of creation of cavernospongiosum shunt of Sacher. The presentation of the treatment technique and early treatment result.

Materials and methods. The case of low-flow priapism lasting 4 days that occurred without any perceptible reason with a 51-year old patient who had to be urgently treated urologically. Medical diagnosis has been set on the basis of the interview and physical examination. In the acute, interventional treatment, rinsing of corpora cavernosa with the physiological salt and the adrenalin solution was performed. Lack of effect resulted in the need of puncture of the corpora cavernosa according to the Winter's procedure and rinsing of corpora cavernosa with the adrenalin solution again. Given the persistence of penis erection despite the treatment procedure used, finally, 48 hours after the patient's admission into the Department of Urology, cavernospongiosum shunt from the perineum access according to Sacher method was performed. Partial flabbiness of the penis was achieved that became more evident and larger after 24 hours and reached its maximum after nearly 100 hours from the surgical intervention.

Results. The course of the after-treatment was uncomplicated. Thanks to the treatment technique applied, the pathologic erection of penis retreated entirely.

Conclusions. The presented treatment technique concerning the creation of caverno-spongiosum shunt is an effective way of treatment regarding long-lasting, persistent low-flow priapism. The modification of treatment presented by Sacher increases the possibility of retreat of the pathologic erection and reduces the risk of after-treatment narrowing of the urethra. This method should be used only ultimately, in extreme conditions, when other methods of treatment fail.