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Failure of Distal shunts for Prolonged Priapism
Jennifer L Bepple, Michael Pryor, Gerald H. Jordan, Kurt A McCammon
Eastern Virginia Medical School, Norfolk, VA

Introduction:
Priapism is initially treated with conservative measures. If this fails, patients then require operative management. Classically, a transglanular to corporal cavernosum shunt (distal shunt) is attempted, followed by a corporal cavernosum to spongiosum shunt (proximal shunt) if this fails. Our objective is to determine if it is appropriate to proceed directly to a proximal shunt if priapism has been present greater than 24 hours.
Methods:
Patients who presented with low flow priapism greater than 24 hours and underwent a distal shunt from 1999 to 2006 were reviewed. We evaluated the success rate of a distal shunt following prolonged priapism.
Results:
Fifteen patients underwent a distal shunt following failed conservative treatment for priapism longer than 24 hours. The length of priapism ranged from 24 hours to 5 days, with a median of 72 hours. One had an unknown length of being priapic. 80% of the distal shunts performed failed.
Conclusions:
In our experience, patients who present with priapism for greater than 24 hours fail conservative management. Traditionally, these patients proceed to transglanular to corporal cavernosal shunt. This practice should be questioned given the high failure rate in those with prolonged priapism. This study is limited by the small patient population, and a multi-center data base to further assess the success rate of distal shunts in patients with priapism longer than 24 hours is warranted.

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