Schifano Nicolò, Capogrosso Paolo, Baldini Sara, Villano Alessio, Cakir Onur Omer, Castiglione Fabio, Antonini Gabriele, Dehò Federico
ASST Sette Laghi - Circolo e Fondazione Macchi Hospital, Varese, Italy.
University of Insubria, Varese, Italy.
Int J Impot Res. 2025 Apr 29. doi: 10.1038/s41443-025-01078-7.
When ischaemic priapism becomes unresponsive to aspiration-irrigation and shunting, poor outcomes for priapism resolution and functional recovery are expected. This study reviews the strategies to improve the outcomes for priapism patients after shunting, based on a comprehensive literature-search on PubMed, Cochrane Library, and EMBASE. Erectile dysfunction is common after shunting, particularly in cases of pre-existing erectile dysfunction, older age, recurrent priapism, or necrosis detected by magnetic resonance imaging. Distal shunts are typically adopted as first-line options. Systemic anticoagulation may prevent thrombus-formation, which may lead to recurrence of ischaemic priapism. Both selective and non-selective phosphodiesterase type 5 inhibitors may enhance erectile function recovery and prevent priapism recurrence. A repeat penile blood gas analysis can help determine whether there has been a conversion to non-ischaemic priapism if shunts fail. Proximal shunts and the penoscrotal decompression can be considered when distal shunting does not result in complete detumescence. Early malleable penile prosthesis implantation is an option after shunting failure. Use of vacuum erection device regimens should be encouraged after shunting to minimize penile fibrosis, especially when late penile prosthesis implantation is needed due to erectile dysfunction previously unresponsive to medical management. More evidence is needed to achieve consensus regarding the optimal management of ischaemic priapism after shunting, and surgical innovation should continue to refine the current techniques.
当缺血性阴茎异常勃起对抽吸冲洗和分流治疗无反应时，阴茎异常勃起消退及功能恢复的预后较差。本研究基于对PubMed、Cochrane图书馆和EMBASE的全面文献检索，回顾了改善分流术后阴茎异常勃起患者预后的策略。分流术后勃起功能障碍很常见，尤其是在既往存在勃起功能障碍、年龄较大、复发性阴茎异常勃起或磁共振成像检测到坏死的情况下。远端分流通常作为一线选择。全身抗凝可预防血栓形成，而血栓形成可能导致缺血性阴茎异常勃起复发。选择性和非选择性5型磷酸二酯酶抑制剂均可增强勃起功能恢复并预防阴茎异常勃起复发。如果分流失败，重复进行阴茎血气分析有助于确定是否已转变为非缺血性阴茎异常勃起。当远端分流未导致完全消肿时，可考虑近端分流和阴茎阴囊减压。分流失败后可选择早期植入可屈性阴茎假体。分流后应鼓励使用真空勃起装置方案，以尽量减少阴茎纤维化，尤其是当因先前药物治疗无效的勃起功能障碍而需要晚期植入阴茎假体时。需要更多证据以就分流术后缺血性阴茎异常勃起的最佳管理达成共识，并且手术创新应继续完善现有技术。
