Early penile prosthesis insertion in the delayed presentation of ischemic priapism

Ischemic priapism is an organ-threatening event. It presents as a rigid and painful erection despite the absence of any sexual stimulation. In up to 60% of cases of ischemic priapism no precipitating factor is identified. However, medications such as intra-cavernosal agents, anti-psychotics, anti-hypertensives, as well as illicit drug use and hematological disorders have been implicated in ischemic priapism. Management of a prolonged priapism is challenging. It is usually refractory to aspiration, intra-carvenosal phenylephrine, and even surgical shunting. The corpora carvenosa can be irreversibly replaced by dense fibrosis after 6 hours of ischemia. This may result in a shortened, indurated, non-erectile penis. We present and describe the surgical technique of a case of prolonged ischemic priapism treated with early implantation of penile prosthesis.