EXTRACORPOREAL MANAGEMENT L. LAWSON

CIRCULATORY

OF PRIAPISM

DOUGLAS,

M.B.B.S.,

F.R.C.S.

From the Department of Urology, Kingston Regional Hospital, Kingston, Jamaica, West Indies

The conservative management of priapism has very limited success as judged by detumescence, relief of pain, and return ofpotency. In most cases only after many days or even weeks of pain will the erection subside, and then almost always the patient will be impotent. Operative procedures which have a high degree of success in relieving erection and pain entail the creation of an alternative vascular drainage pathway for the corpora cavernosa, for example, the corpora saphenous shunt and the cavernosa-spongiosum shunt. l-4 Studies of patients who have had these procedures show that in some cases the surgically created channels thrombose in the early postoperative period without compromising the success of management.5-8 It would seem that the beneficial effects of these shunting procedures in restoring physiologic detumescence occur relatively soon

after their creation. A simple temporary cavernosa-to-peripheral-vein shunt should, therefore, also produce a permanent regression of priapism. Method In eight patients to date, a temporary shunting of blood from the corpora cavernosa to an arm vein has been performed, utilizing a hemodialysis arterial line catheter, modified for placement in the corpora cavernosum, and hemodialysis tubing with a roller pump in the circuit (Fig. 1). The pump is stopped at two-hour intervals to determine if the penis remains soft, and the procedure is discontinued when this is achieved. The dark thick blood is evacuated from the corpora cavernosa before the arterial cannula is introduced. The patient is heparinized during the procedure.

/ROLLER

PUMP

UBBLETRAP

FIGURE 1.

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UROLOGY

circuit.

/ FEBRUARY 1976 / VOLUME

VII, NUMBER 2

Results Tumescence and pain were relieved in all patients who were allowed to remain on extracorporeal circulation until the penis was flaccid, although the time taken to achieve this varied. Return of potency, as in other surgical procedures, varied inversely with the time of onset of priapism before surgery was performed. Two patients have admitted full potency, 2 although achieving satisfactory erections are not what they were before, and 4 have become impotent. Angiographic studies of the corpora in various stages of erection showed that occlusion of the venous drainage was mainly responsible for the maintenance of priapism. Tonometric studies were used as an objective guide to the progress of treatment. Advantages of this method over other surgical procedures are (1) surgical simplicity; (2) minimal anatomic disturbance, saphenous vein, corpora spongiosum; and (3) in the event of recurrent priapism, as in sickle cell disease, the procedure may be repeated.

UROLOGY /

FEBRUARY 1976 I VOLUME VII, NUMBER 2

2 Eureka Crescent Kingston 5, Jamaica, West Indies References 1. GRAYHACK,J. T., MCCULLOUGH, W., O’CONNOR, V. J., and TRIPPEL, 0.: Venous bypass to control priapism, Invest. Urol. 1: 509 (1964). 2. QUACKELS, R.: Cure of a patient suffering from priapism by cavernospongiosum anastomosis, Acta Ural. Belg. 32: 5 (1984). 3. SACHER, E. C., et al. : Cavernospongiosum shunt in the treatment of priapism, J. Ural. 108: 97 (1972). 4. FALK, D., and LOOS, D. C.: Spongiocavemosum shunt in the surgical treatment of idiopathic persistent priapism, ibid. 108: 101 (1972). 5. GARRETT, R. A., and RHAMY, D. E.: Priapism, management with corpus-saphenous shunt, ibid. 95: 65 (1966). 6. MARTIN, D. C., SCHAPIRO, A., and BURKHOLDER,G. V. : Corpus cavernosum-saphenous-vein anastomosis for priapism, ibid. 102: 221 (1969). 7. BEID, E. C., and HOMSY, Y.: Treatment of priapism by caverno-saphenous bypass, Br. J. Urol. 44: 86 (1972). 8. WELLWOOD, J. M., BULTITUDE, M. I., RICKFORD, C., and THOMAS, M. L.: The role of corpus-saphenous bypass in the treatment ofpriapism, ibid. 44: 607 (1972).

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EXTRACORPOREAL MANAGEMENT L. LAWSON CIRCULATORY OF PRIAPISM DOUGLAS, M.B.B.S., F.R.C.S. From the Department of Urology, Kingston Regional Hospit...
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