Salvage management of prolonged ischemic priapism: Al-Ghorab shunt plus cavernous tunneling with blunt cavernosotomy.
The management of ischemic priapism (IP), especially in cases of prolonged IP (PIP), is enigmatic. The T-shaped shunt and intracavernous tunneling and the corporal "snake" maneuver have been reported as effective surgical procedures for PIP; however, management of the PIP that is refractory to these procedures is controversial. The present study is a report of two PIP cases that were successfully treated by a novel technique. Two cases with 5- and 7-day histories of IP that were refractory to T-shaped shunt and intracavernous tunneling or the corporal "snake" maneuver, respectively, were included in this study. After creating the Al-Ghorab distal shunts, part of the cavernous tissue was bluntly excised with Pean forceps through the shunts to create a large drainage route. The effectiveness, safety and effect on erectile function after this procedure were assessed. In both cases, the erection and penile pain were immediately diminished, and corporal blood flow measured by color Doppler ultrasonography was restored after the surgery. There was no urethral injury or perforation of the tunica albuginea. Pathological findings showed that the excised tissues were fibrotic and necrotic. There was no recurrence of IP after the salvage surgery. One patient noticed partial erection, and the administration of sildenafil was effective for completing sexual intercourse. Al-Ghorab distal shunt plus cavernous tunneling with blunt cavernosotomy creates a large blood drainage route by removing the necrotic or fibrous cavernous tissues. Further investigation regarding to erectile function is needed; however, this procedure is safe and effective even in repeat cases after T-shaped shunt and intracavernous tunneling or the corporal "snake" maneuver.