Prosthesis may offer relief from intractable priapism

Men with intractable priapism obtained immediate pain relief with few complications after implantation of a malleable penile prosthesis, data from a small clinical series showed.

The 13 patients included in the study had a mean priapism duration of 82 hours prior to implantation of the prosthesis. Prior to the implantation procedure, the estimated cost of care for the men was $83,818. The prosthesis costs $4,200, reported first author Michael J. Belsante, MD, of the University of Texas Southwestern Medical Center in Dallas, working with Allen Morey, MD.

“Refractory priapism is associated with multiple emergency department visits, multiple hospitalizations, and a penile prosthesis in the acute setting is efficacious in treating refractory priapism durably with cost and resource benefits,” said Dr. Belsante.

The clinical series consisted of 12 patients with refractory ischemic priapism and one with stuttering priapism during the course of a 14-day hospital stay. Etiology was sickle cell anemia in three cases, medication induced in three cases, and idiopathic in the remaining seven cases.

The series had accumulated since 2007, when Parkland Memorial Hospital adopted a policy of accepting the malleable penile prosthesis on consignment for acute management of refractory ischemic priapism.

Before the implantation, the men had an average of 4.5 emergency department visits, two hospital admissions, 1.5 shunt procedures, five irrigation and drainage procedures involving phenylephrine injection, and six days in the hospital.

Following implantation of the penile prosthesis, all patients were discharged within 24 hours. The procedures have been associated with two complications: one infection requiring explantation of the prosthesis and one case of urethral erosion, which occurred early in the clinical experience with the implantable prosthesis. The patient with the erosion subsequently underwent implantation of an inflatable penile prosthesis, Dr. Belsante said.

Dr. Morey has disclosed that he serves as a consultant/advisor to American Medical Systems, Coloplast, and GlaxoSmithKline.

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