Management of Priapism: A Contemporary Review.
Management of Priapism: A Contemporary Review.
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DOI：
10.1016/j.sxmr.2019.01.001
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发表时间：
2019
影响因子：
3.6
通讯作者：
Kirtishri Mishra;A. Loeb;L. Bukavina;A. Baumgarten;J. Beilan;M. Mendez;L. Digiorgio;L. Fu;R. Carrion
中科院分区：
文献类型：
--
作者：
Kirtishri Mishra;A. Loeb;L. Bukavina;A. Baumgarten;J. Beilan;M. Mendez;L. Digiorgio;L. Fu;R. Carrion
目前对缺血性异常勃起的治疗主要围绕3个原则：解决急性事件，保留勃起功能，减少未来复发的风险。虽然更保守的治疗方案，如抽吸、冲洗和手术分流，在许多患者中是有效的，但那些对这些干预措施无效或阴茎勃起持续时间较长的患者可能受益于放置阴茎假体(PP)。目的全面概述阴茎异常勃起的治疗，突出当前文献中关于阴茎植入物治疗难治性阴茎异常勃起的有效性的文献，并从大量的手术决策和技术中心提供见解。评估了相关的算法，并将我们的经验覆盖在文献中存在的数据上。主要结果衡量标准评估了当前异常勃起的处理算法。随后，对急性和延迟放置PP的数据进行了评估。术后感染率、勃起功能障碍和患者满意度也被检测。结果总体而言，延迟和早期PP植入物的失败率均高于常规PP植入物。对于难治性或长期阴茎异常勃起的患者，早期植入可能在技术上更容易，减少了阴茎长度的丢失和相关的并发症。结论应对患者进行个体化评估，并在早期和延迟的时间框架内咨询PP植入的风险和好处。尽管目前还没有关于理想的植入装置或时机的确凿证据，但可塑性假体和充气假体以及急性和延迟植入的利弊是明确的。
IntroductionCurrent management of ischemic priapism revolves around 3 principles: resolving the acute event, preserving erectile function, and reducing the risk of future recurrences. Although more conservative management options, such as aspiration, irrigation, and surgical shunts, are effective in many patients, those who are refractory to these interventions or have prolonged priapism may benefit from placement of a penile prosthesis (PP).AimTo provide a comprehensive overview of priapism management, highlight the current literature on the utility of penile implants for refractory priapism, and provide insight from a high-volume center on surgical decision making and technique.MethodsA complete review of the current guidelines and associated literature was performed. Associated algorithms were evaluated, and our experience was overlaid on the data present in the literature.Main Outcome MeasuresThe current management algorithm for priapism was evaluated. Subsequently, the data on acute and delayed PP placement were assessed. Rates of postoperative infection, erectile dysfunction, and patient satisfaction were also examined.ResultsOverall, both delayed and early PP implants are associated with higher rates of failure than routine PP implants. In patients with refractory or prolonged priapism, early implantation may be technically easier, with decreased loss of penile length and associated complications.ConclusionPatients should be evaluated on an individual basis and counseled on the risks and benefits of PP implantation in early and delayed time frames. Although there is no definitive evidence at this time regarding the ideal device or timing of implantation, there are well-established pros and cons of malleable vs inflatable prostheses and of acute vs delayed implantation.