Penile Implant Insertion in Post Priapism; the Indications, Procedure, Limitations and Complications.

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Muzzammil Abdullahi, Sani Alhassan Usman This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8834822/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background Priapism is a clinical state in which there is persistent usually painful penile erection often in the absence of erotic psychic stimuli or fails to subside despite orgasm. This is a urological emergency which may cause damage to the corporal tissue and ED. Method This was a combined retrospective and prospective study to determine patient presentation and the indications,surgical procedure, limitations and complications of penile implant insertions in patients who presented with priapism sequelae. The subjects were all consenting patients who presented to our hospital with priapism sequelae and who had initial management of the priapism (in our hospital or elsewhere) and eventually had insertion of malleable penile implant in our hospital from January 2017 to June 2024. The records of all the information on the patients was retrieved (and recorded) from our register/electronic records for those included retrospectively while those included prospectively, records were taken as at the time of treatment. Results A total of 46 patients were recruited into the study with 14 of them presented in refractory priapism and the 32 presented with corporal fibrosis following poorly treated priapism. The patients were distributed into the 2 groups above and parameters calculated differently to explore any advantage in management of one group over the other. The age distributions differ with the refractory priapism group having a mean age of 24±3.6 years and the corporal fibrosis group of 37±9.7 years (t= -4.85, p= 0.00002). Sickle cell disease was the predominant cause of Priapism (69.6%). On initial presentation, majority (73.9%) had acute ischemic priapism while the remaining 27.1% had stuttering priapism. The intra-operative findings were that of dark blood with necrotic tissues in the refractory priapism group (21.7%) and varying degree of fibrosis in the corporal fibrosis group (69.6%). The duration of the surgery, length and diameter of the implant differ in the 2 groups with a p-value of <0.00001, 0.0018, <0.00001 respectively. Complications recorded include surgical site infection (17.4%), corporal perforation (6.5%) and implant infection (4.3%). Erectile function improved with IIEF score of 25-30 in 95.6% of our patients. Conclusion Penile implant insertion in both refractory priapism and corporal fibrosis is effective and safe procedure for the prevention or treatment of ED. A satisfactory sexual function and few or no complications are achieved if standard peri-operative procedures are followed. Priapism Refractory priapism Corporal Fibrosis Penile implant Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 BACKGROUND Priapism is a clinical state in which there is persistent usually painful penile erection often in the absence of erotic psychic stimuli or a condition in which erection fail to subside despite orgasm [ 1 ]. This is a urological emergency resulting from the disturbance of the normal regulatory mechanism controlling penile erection and flaccidity (dysregulation of the normal neurovascular and veno-occlusive mechanisms which mediate physiological erection) [ 2 ]. There are three subtypes of priapism: ischaemic, non-ischaemic, and stuttering priapism (also known as recurrent ischaemic priapism). Ischaemic priapism is by far the commonest subtype and accounts for more than 95% of all priapism episodes [ 3 ]. Both stuttering and ischemic priapism result in the same consequence, namely, ischemic damage to the corporal tissue which over time result in tissue injury that accumulates and develops into permanent ED [ 2 , 3 ]. Studies have shown that ischemic priapism lasting longer than 24 h results in ED rates as high as 90%. It is intuitively, that all patients affected by ischemic priapism lasting over 36 hours, have no chance to regain full erectile function [ 1 ]. Therefore, ischemic priapism constitutes a true emergency that must be treated in a time-sensitive manner. Any delay in the presentation or failure to intervene in a timely fashion can lead to irreversible erectile dysfunction, penile shortening, loss of penile girth, and penile curvature [ 4 , 5 , 6 , 7 ]. While priapism is a rare disorder, sickle cell disease (SCD) individuals are affected with greater frequency relative to the general population [ 8 ]. The prevalence of priapism in these men range from 31–42% [ 1 , 9 , 10 ]. Individuals with SCD- related priapism also have a higher rate of penile deformities, lower sexual desire, lower intercourse satisfaction, and overall decreased satisfaction with sex life compared with those without a history of priapism [ 8 ]. Other conditions associated with priapism include hematologic dyscrasias, such as glucose-6-phosphate dehydrogenase deficiency, thrombophilias, hyper viscosity states, anticoagulants, psychiatric medications (most notably the sedative trazodone, as well as selective serotonin reuptake inhibitors), anti-hypertensives (α-adrenergic antagonists), malignancy (most commonly bladder, prostate, kidney and colorectal), total parenteral nutrition, recreational drug use such as cocaine, heavy alcohol abuse, ingestion of herbal preparations and trauma [ 3 , 4 , 5 , 7 , 11 ]. Emergency medical management is the first option of treatment for priapism. These include adequate hydration, analgesics, antibiotics and corporal aspiration/irrigation with vasoactive agent. Detumesence may easily be achieved in early presentation unlike in delayed cases that often require surgical intervention, creating a permanent shunt between the cavernous bodies and the glans or the corpus spongiosum [ 4 , 11 ]. Early penile prosthesis (PP) implantation in refractory IP has been proposed by some Authors, which can offer many advantages for these patients including resolving painful erection, providing sufficient rigidity for satisfactory intercourse, and countering inevitable penile shortening, seen in cavernous fibrosis. [ 12 ] Moreover, the immediate implantation of PP is easier to perform when compared with late insertion in corporal fibrosis [ 12 ]. Extensive corporal fibrosis usually results in severe ED that is unresponsive to all non-invasive treatments e.g. phosphodiesterase 5 (PDEI-5) inhibitors, intracorporal injection of vasoactive drug (ICIVAD), or shock wave. Penile prosthesis is the definite option of treatment. The presence of significant corporal fibrosis can pose a substantial technical challenge to PPI surgery both in terms of corporal dilation and a higher risk of prosthesis infection and malfunction [ 13 ]. Over the years, multiple surgical approaches have been suggested to facilitate implantation in this difficult situation which includes the resection of scar tissue, the performance of extensive corporotomies and the eventual use of grafts to cover the corporal gap [ 13 , 14 ]. In the light of this, the choice of either early or late insertion of PP depends on patient presentation, the technical complexity of surgery, the cost-related issue and the possible unavailability of the devices in many centers or in emergency settings. In this study, we compared our findings of the early insertion of PP in acute / stuttering priapism and late insertion in corporal fibrosis. METHOD This study was a combined retrospective and prospective study to to determine patient presentation and the indications, surgical procedure, limitations and complications of penile implant insertions in patients who presented with priapism sequelae particularly refractory priapism or corporal fibrosis. The subjects were all consenting patients with either refractory priapism Or corporal fibrosis and erectile dysfunction (IIEF of ≤ 10) that presented/ were referred, to Aminu Kano Teaching Hospital [AKTH], Kano from January 2017 to June 2024. The patients were distributed into the 2 groups (refractory priapism and corporal fibrosis) and parameters calculated differently to explore any advantage in management of one group over the other. This approach was earlier used by Baher Salman et’al in their study [ 15 ]. The first group was those who presented with priapism refractory to treatment options aimed at achieving detumuscence (corporal aspiration/shunting procedure). Patients in this group were counseled and encouraged to having the penile implant insertion as early as possible. The second group of patients was those who already developed corporal fibrosis and ED from poorly treated/untreated priapism (IIEF-5 Score of 1–10. This group was also counseled and encouraged to have the penile implant insertion at an elective date. Patients in both groups were educated on the device and its working, the surgical procedure and potential complications such as implant-related infection, corporal perforation and sizing problems. Detailed information was contained in Patient’s information sheet and consent form. All the consenting patients in the first group on presentation had baseline investigations such as full blood count [FBC], serum Electrolytes, Urea and Creatinine [EUCr], and urinalysis. They were resuscitated including intravenous fluid, intravenous broad spectrum antibiotics and blood transfusion where indicated. As soon as they were fit, patients were then scheduled for the penile implant insertion. All patients had insertion of Shah’s malleable penile implant, the appropriate size was determined intra-operatively. All procedures were performed under subarachnoid block. The Corpora following corporotomy were thoroughly debrided of necrotic tissues and irrigated with normal saline. Three (3)-Stage antibiotics coverage was observed in all patients; intravenous cefriaxone [Rocephin], Implant immersed in Gentimicin and corpora irrigation with ciprofloxacin infusion. Serial cavernotomes and Hager’s Dilators (maximum of 13mm in diameter) were used to achieve adequate dilatation of the corpora. Postoperatively Intravenous antibiotics were continued for 5days. The patients in the second group, who were clinically stable, had the implant insertion at an elective date. They also had a similar retinue of events as in the first group. Patients were reviewed post-operatively at 48hours, 5days, 2weeks, 6weeks and 3months. The case records of patients treated before the commencement of the study [The Retrospective] were retrieved and the required information was extracted. The information was then combined with one obtained from the patients recruited prospectively. Basic demographic data of the participants, the presenting features, the duration of the symptoms (priapism or erectile dysfunction), previous history and duration of priapism and treatment offered, drugs history [ including intake of herbal concoctions] were recorded for all patients. Intra-operative findings including duration of surgery, corporal findings, outcome of dilatations, size of implant use, intra-operative complications, and post-operative penile length and complications among others were recorded. The information obtained was entered into Excel sheets, refined, grouped and then transferred into SPSS Version 21 and analyzed. Independent t-test and Fisher’s exact test were used to assess significance of association. Differences considered statistically significant where p-value was less than 0.05 (p < 0.05). RESULTS A total of 46 patients were recruited into the study with 14 patients into the refractory priapism group and 32 patients into the corporal fibrosis group. The age distributions of the patients is as shown in Fig. 1with the refractory priapism group having a mean age of 24 ± 3.6 years and the corporal fibrosis group of 37 ± 9.7 years. The age difference in the 2 groups is statistically significant (t= -4.85, p = 0.00002). Figure I: Age Distribution of the Patients Sickle cell disease is the predominant cause of Priapism among our patients as shown in Table 1 Table I: Causes of Priapism Risk Factor Frequency/Percent (n/%) Cumulative n/% Refractory priapism Corporal fibrosis Sickle cell disease Use of aphrodisiacs Herbal concoctions idiopathic Total 14/30.4 0/0 0/0 0/0 14/30.4 18/39.2 4/8.7 6/13.1 4/8.7 32/69.6 32/69.6 4/8.7 6/13.1 4/8.7 46/100 Majority of the patient (73.9%) initially presented with ischaemic priapism while the remaining 27.1% presented with stuttering priapism, and none with non-ischaemic priapism. They most commonly (93.5%) presented after 24 hours of onset of the priapism. Typically, the patients in the first group presented with refractory priapism as shown in Fig II. The most common early management modality for the treatment of acute priapism was found to be intravenous hydration with Normal saline in 47.8%, while 28.7% and 8.7% of the patients had corporal aspiration/irrigation with normal saline± adrenaline and shunting procedures respectively. Five patients (10.9%) did not have any form of treatment. The IIEF (Domain A= Erectile function) score in all the patients who presented with ED from corporal fibrosis was 1–10 (severe ED) while this was not applicable for those who presented in acute/stuttering priapism. The intra-operative findings in both groups are as shown in Table II. The duration of the surgery, the length and diametre of the implant used in the 2 groups differ as shown in Table III. In early insertion the typical finding is that of dark venous blood/ necrotic tissues as shown in Fig III. Fig II: Refractory Priapism Fig III:Cavernosal finding in refractory priapism Table II: Intra-operative Findings Duration Frequency/Percent (n/%) Cumulative n/% Refractory priapism Corporal fibrosis Dark Blood/Necrotic tissues Dark Blood/Corporal Fibrosis Whole Corporal Fibrosis Proximal Corporal Fibrosis Multiple sites Fibrosis Total 10/21.7 4/8.7 0/0 0/0 0/0 14/30.4 0/0 0/0 20/43.5 10/21.7 2/4.4 32/69.6 10/21.7 4/8.7 20/43.5 10/21.7 2/4.4 46/100 Table III: Duration of Surgery/Dimensions of Implant used Variable Mean/Standard Deviation t- test value p-value Refractory Priapism Corporal Fibrosis Duration of Implant Insertion (minutes) Length of Implant(cm) Diameter of Implant(mm) 110 ± 20 20 ± 2.5 12 ± 1 160 ± 30 18 ± 1.5 10 ± 0.7 -5.69 5.72 7.69 < 0.00001 0.0018 < 0.00001 Majority of our patients had no complications both intra and post- operatively. However, the few complications recorded in both groups were shown in Table IV and V. An implant infection and floppy glans recorded in our patients are shown in Fig IV and V respectively. At 3 months follow up, erectile function was re-assessed, 44 patients (95.7%) reported satisfactory erectile function IIEF (Domain A= Erectile function) score of 25–30. Table IV: Intra-operative Complications Complications Frequency/percent (n/%) Refractory Priapism Corporal fibrosis Corporal Perforation Implant-Corpora disproportion Urethral Injury 0/0 0/0 0/0 3/6.5 2/4.3 1/2.2 Table V: Post- operative Complications Complications Frequency/percent (n/%) Cumulative n/% p-value* Refractory priapism Corporal fibrosis Floppy glans Haematoma Surgical site infection Implant Infection 0/0 1/2.2 4/8.7 2/4.3 1/2.2 1/2.2 4/8.7 0/0 1/2.2 2/4.3 8/17.4 2/4.3 1 0.521 0.223 0.089 *Fisher’s exact test Fig IV: Implant Infection with distal perforation Fig V: Floppy glans penis DISCUSSION Priapism though a rare condition is associated with ED that may adversely affect patient psyco-social health. Erectile dysfunction is usually of severe form and results from late presentation or poor treatment of priapism. Penile implant insertion is the gold standard management option for severe ED of varying aetiology. Its use in patients with severe corporal fibrosis following priapism has been reported to be associated with long duration of surgery and high rate of complication. The early insertion of penile implant in patients with priapism may resolve these reported disadvantages. This may be even more indicated in our environment which has high SCD patients burden with high priapism rate [ 8 , 16 , 17 ]. From our results majority of the patients are less than 40 years of age. Priapism has been reported to have bimodal peak of incidence between 5–10 years and 20–50 years [ 1 ]. Also previous studies from our environment recorded similar age range [ 4 , 7 , 8 , 10 , 11 , 18 ]. Sickle cell disease was the sole cause of priapism among all the patients with refractory priapism and the predominant cause in the corporal fibrosis group. Sickle cell disease has remained the predominant cause of priapism particularly in high SCD burden environment. This is similar to findings in other studies on priapism from the same environment [ 4 , 7 , 11 ] but differs from findings of studies from Asia and Europe [ 12 , 19 ] who have lower SCD burden. In a study in Kano, Nigeria, SCD patients have been shown to have high prevalence of any priapism episode when compared with non SCD patients [ 8 ]. Majority of the patients (93.5%) presented to the hospital after 24hrs of onset of priapism and mostly of acute ischaemic type. Acute ischaemic priapism has been shown to be associated with high rate of ED and this even worsen with long duration (> 24hrs) of priapism before any intervention. Late presentation was also attributed to ignorance, feeling of shame, use of herbal preparations and inappropriate counsel by healthcare providers [ 4 , 7 , 11 ]. Most common interventions our patients had on presentation with priapism were intravenous fluid hydration, analgesics and corporal aspiration (± irrigation with epinephrine). Timely corporal aspiration and irrigation with normal saline ±adrenaline has also been shown to reduce the occurrence of ED following priapism [ 5 , 12 ]. Only 37.4% of our patients had corporal aspiration / irrigation or shunts procedure. Late presentation and low practice of corporal aspiration in most of our patients further explained why all the patients in the corporal fibrosis group presented with severe ED, IIEF (Domain A= Erectile function) score of 1–10. This pattern of treatment for priapism is similar to findings from earlier studies done in the same environment [ 4 , 11 ]. This might be attributed to dearth of urologists in the healthcare centres across the region that could provide such interventions. The intra-operative findings in the refractory priapism group showed extensive darkening of the corpora with necrotic tissues as a result of ischaemia. A thorough debridement including excision of all brisk areas on the corporal walls until fresh bleeding ensues was an essential step in preventing implant infection among our patients. The corporal fibrosis group showed fibrosis of varying severity depending on duration of the priapism and nature of intervention. Obstruction of the penile venous outflow as typically seen in priapism which leads to stasis of blood within the corpus cavernosum akin to a compartment syndrome, results in the development of hypoxia, acidosis, and glucopenia that results in smooth muscle dysfunction and later fibrosis. The longer the duration of ischaemia the more extensive is the fibrosis [ 2 ]. The duration of the surgery in the two groups was noted to be significantly longer in the corporal fibrosis group owing to difficult dilatation of the corpora due to extensive fibrosis in most of the patients. Adequate corporal dilatation is a key step to successful implant insertion. Dilatation goes serially and guided in order to avoid such complications as corporal perforation hence, takes longer time in severe fibrosis. Similar results were noted by Baher Salman et’al in their study [ 15 ]. Similarly, both the length and diameter of the implants used in the 2 group shows significant difference. The final length and diameter of the implants used were determined intra-operatively. The refractory priapism group in addition to having a seemingly easier surgery, longer and thicker implants were inserted hence maintaining a better penile anatomy and more satisfactory sexual performance. In the corporal fibrosis group, varying degree of fibrosis narrowed the corporal lumen which in most cases limited the dilatation in length and width hence, a less firmly erect penis was achieved. Also Baher Salman et’al obtained similar findings in a previous study in Egypt [ 15 ]. Only a few of our patients developed complications (intra-operative and post-operative). Complications rate is generally low if standard peri-operative procedures re adhered to. Major complication associated with implants insertion has been implant-related infection which in our patients is comparatively higher in the refractory priapism group (4.8% vs 0%). High Implant infection rate has been reported in patients with acute priapism due to mainly corporal ischaemia and contamination from prior corporal aspiration/shunts [ 20 ]. Few other complications such as urethral injury, corporal perforation and floppy glan were recorded among our patients. Generally, complications are significantly low where standard peri-operative procedures are followed [ 20 ]. Except for initial difficulty in penetrative intercourse and glans hypo sensitivity, majority of the patients (95.7%) had satisfactory sexual function 3months after implant insertion. Similar results were reported by Franco P and colleagues [ 21 ]. CONCLUSION Penile implant insertion in both refractory priapism and corporal fibrosis is effective and safe procedure for the prevention or treatment of ED. While in refractory priapism, insertion is easier and tends to maintain normal penile anatomy, it carried higher infectivity rate particularly when corpora are not properly debrided and irrigated with normal saline and antibiotics. On the other hand, insertion in corporal fibrosis carry longer operation time and difficult dilatation, however, has lower infectivity rate and tends to restore patient lost erectile function though with less firm penis. Abbreviations AKTH- Aminu kano teaching hospital, Kano ED- Erectile dysfunction EUCR- Electrolytes, urea and creatinine FBC- Full blood count ICIVAD - Intracavernosal injection of vasoactive drugs IIEF- International index of erectile function IP- Ischaemic priapism PDEI-5 - 5- phospho di-esterase inhibitors PP - Penile prosthesis PPI- Penile prosthesis insertion SCD- Sickle cell disease Declarations Ethical approval The ethical approval for the conduct of the study was obtained from the Research Ethics Committee (REC) of the AKTH with reference number –NHREC/28/01/2020/AKTH/EC/3693 Patients signed informed consent. Consent for publication Not applicable Availability for data and material All data generated or analysed during this study are included in this published article [and its supplementary information files. Competing interest The authors declare that they have no competing interests Funding No funding was received. The researchers have no affiliation to any of the companies whose products were used in the course of this study. Authors Contribution MA conceived this research MA and SUA were involved in concept development and reviewed existing literature MA entered and later extracted the information of patients from questionnaire MA analysed the data SUL wrote the introduction and discussion All authors read and agreed with the final manuscript and agreed to present it for publication Acknowledgement Our sincere appreciation goes to the management of Aminu Kano Teaching Hospital, Kano, Nigeria for granting us ethical approval and permission to conduct the study. We also appreciate Drs Abubakar, Suleiman and Aisha all of Department of surgery for their help in printing the questionnaire and retrieving some patients medical records. The medical records department and main operating theatre staff are also appreciated for their contribution to the success of this work. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8834822","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":635027933,"identity":"c68a0742-ab82-4c20-a083-d06355feb282","order_by":0,"name":"Muzzammil 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Kano","correspondingAuthor":false,"prefix":"","firstName":"Sani","middleName":"Alhassan","lastName":"Usman","suffix":""}],"badges":[],"createdAt":"2026-02-09 23:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8834822/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8834822/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109076718,"identity":"306f4b83-2399-4f12-9eb0-846a4add2bcd","added_by":"auto","created_at":"2026-05-12 11:04:29","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45194,"visible":true,"origin":"","legend":"\u003cp\u003eAge Distribution of the Patients\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8834822/v1/3842ec57b3449ccd705993dd.png"},{"id":109076981,"identity":"9928f81a-11b8-478b-b30d-2efc6b45efd4","added_by":"auto","created_at":"2026-05-12 11:05:56","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":370508,"visible":true,"origin":"","legend":"\u003cp\u003eRefractory Priapism\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8834822/v1/4375ddad00bbd0677732393c.png"},{"id":109077026,"identity":"01c310db-4d6c-4b36-a00a-46ac780d7d09","added_by":"auto","created_at":"2026-05-12 11:06:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":698767,"visible":true,"origin":"","legend":"\u003cp\u003eCavernosal finding in refractory priapism\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8834822/v1/630d192314d1a961d7fe4cc0.png"},{"id":109076985,"identity":"5c42b947-00b1-442d-a946-5673156b8709","added_by":"auto","created_at":"2026-05-12 11:05:57","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":525823,"visible":true,"origin":"","legend":"\u003cp\u003eImplant Infection with distal perforation\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8834822/v1/62650825695803a2cd7b83d9.png"},{"id":109076733,"identity":"b0f6452b-e925-4c48-bc71-276611f6b176","added_by":"auto","created_at":"2026-05-12 11:04:32","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":416813,"visible":true,"origin":"","legend":"\u003cp\u003eFloppy glans penis\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8834822/v1/90c187bdeac57e41fdf71d46.png"},{"id":109204555,"identity":"bea055ee-184a-490e-bec4-f70be306faf2","added_by":"auto","created_at":"2026-05-13 15:01:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2930797,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8834822/v1/ea544ffc-c6b8-410b-8bf5-e826ff4ad97b.pdf"},{"id":109077055,"identity":"4dbdf9d2-339c-4705-bf1c-d0ad343c0aec","added_by":"auto","created_at":"2026-05-12 11:06:33","extension":"xlsx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":13547,"visible":true,"origin":"","legend":"","description":"","filename":"DataEarlyvsdelayedimplantinsertioninSCD.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-8834822/v1/d57060f34a005a21fbae96c7.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePenile Implant Insertion in Post Priapism; the Indications, Procedure, Limitations and Complications.\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003ePriapism is a clinical state in which there is persistent usually painful penile erection often in the absence of erotic psychic stimuli or a condition in which erection fail to subside despite orgasm [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This is a urological emergency resulting from the disturbance of the normal regulatory mechanism controlling penile erection and flaccidity (dysregulation of the normal neurovascular and veno-occlusive mechanisms which mediate physiological erection) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. There are three subtypes of priapism: ischaemic, non-ischaemic, and stuttering priapism (also known as recurrent ischaemic priapism). Ischaemic priapism is by far the commonest subtype and accounts for more than 95% of all priapism episodes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Both stuttering and ischemic priapism result in the same consequence, namely, ischemic damage to the corporal tissue which over time result in tissue injury that accumulates and develops into permanent ED [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies have shown that ischemic priapism lasting longer than 24 h results in ED rates as high as 90%. It is intuitively, that all patients affected by ischemic priapism lasting over 36 hours, have no chance to regain full erectile function [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTherefore, ischemic priapism constitutes a true emergency that must be treated in a time-sensitive manner. Any delay in the presentation or failure to intervene in a timely fashion can lead to irreversible erectile dysfunction, penile shortening, loss of penile girth, and penile curvature [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile priapism is a rare disorder, sickle cell disease (SCD) individuals are affected with greater frequency relative to the general population [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The prevalence of priapism in these men range from 31\u0026ndash;42% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Individuals with SCD- related priapism also have a higher rate of penile deformities, lower sexual desire, lower intercourse satisfaction, and overall decreased satisfaction with sex life compared with those without a history of priapism [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOther conditions associated with priapism include hematologic dyscrasias, such as glucose-6-phosphate dehydrogenase deficiency, thrombophilias, hyper viscosity states, anticoagulants, psychiatric medications (most notably the sedative trazodone, as well as selective serotonin reuptake inhibitors), anti-hypertensives (α-adrenergic antagonists), malignancy (most commonly bladder, prostate, kidney and colorectal), total parenteral nutrition, recreational drug use such as cocaine, heavy alcohol abuse, ingestion of herbal preparations and trauma [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEmergency medical management is the first option of treatment for priapism. These include adequate hydration, analgesics, antibiotics and corporal aspiration/irrigation with vasoactive agent. Detumesence may easily be achieved in early presentation unlike in delayed cases that often require surgical intervention, creating a permanent shunt between the cavernous bodies and the glans or the corpus spongiosum [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly penile prosthesis (PP) implantation in refractory IP has been proposed by some Authors, which can offer many advantages for these patients including resolving painful erection, providing sufficient rigidity for satisfactory intercourse, and countering inevitable penile shortening, seen in cavernous fibrosis. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Moreover, the immediate implantation of PP is easier to perform when compared with late insertion in corporal fibrosis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExtensive corporal fibrosis usually results in severe ED that is unresponsive to all non-invasive treatments e.g. phosphodiesterase 5 (PDEI-5) inhibitors, intracorporal injection of vasoactive drug (ICIVAD), or shock wave. Penile prosthesis is the definite option of treatment. The presence of significant corporal fibrosis can pose a substantial technical challenge to PPI surgery both in terms of corporal dilation and a higher risk of prosthesis infection and malfunction [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOver the years, multiple surgical approaches have been suggested to facilitate implantation in this difficult situation which includes the resection of scar tissue, the performance of extensive corporotomies and the eventual use of grafts to cover the corporal gap [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the light of this, the choice of either early or late insertion of PP depends on patient presentation, the technical complexity of surgery, the cost-related issue and the possible unavailability of the devices in many centers or in emergency settings.\u003c/p\u003e \u003cp\u003eIn this study, we compared our findings of the early insertion of PP in acute / stuttering priapism and late insertion in corporal fibrosis.\u003c/p\u003e"},{"header":"METHOD","content":"\u003cp\u003eThis study was a combined retrospective and prospective study to to determine patient presentation and the indications, surgical procedure, limitations and complications of penile implant insertions in patients who presented with priapism sequelae particularly refractory priapism or corporal fibrosis.\u003c/p\u003e \u003cp\u003eThe subjects were all consenting patients with either refractory priapism Or corporal fibrosis and erectile dysfunction (IIEF of \u0026le;\u0026thinsp;10) that presented/ were referred, to Aminu Kano Teaching Hospital [AKTH], Kano from January 2017 to June 2024.\u003c/p\u003e \u003cp\u003eThe patients were distributed into the 2 groups (refractory priapism and corporal fibrosis) and parameters calculated differently to explore any advantage in management of one group over the other. This approach was earlier used by Baher Salman et\u0026rsquo;al in their study [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe first group was those who presented with priapism refractory to treatment options aimed at achieving detumuscence (corporal aspiration/shunting procedure). Patients in this group were counseled and encouraged to having the penile implant insertion as early as possible. The second group of patients was those who already developed corporal fibrosis and ED from poorly treated/untreated priapism (IIEF-5 Score of 1\u0026ndash;10. This group was also counseled and encouraged to have the penile implant insertion at an elective date.\u003c/p\u003e \u003cp\u003ePatients in both groups were educated on the device and its working, the surgical procedure and potential complications such as implant-related infection, corporal perforation and sizing problems. Detailed information was contained in Patient\u0026rsquo;s information sheet and consent form.\u003c/p\u003e \u003cp\u003e All the consenting patients in the first group on presentation had baseline investigations such as full blood count [FBC], serum Electrolytes, Urea and Creatinine [EUCr], and urinalysis. They were resuscitated including intravenous fluid, intravenous broad spectrum antibiotics and blood transfusion where indicated. As soon as they were fit, patients were then scheduled for the penile implant insertion. All patients had insertion of Shah\u0026rsquo;s malleable penile implant, the appropriate size was determined intra-operatively. All procedures were performed under subarachnoid block. The Corpora following corporotomy were thoroughly debrided of necrotic tissues and irrigated with normal saline. Three (3)-Stage antibiotics coverage was observed in all patients; intravenous cefriaxone [Rocephin], Implant immersed in Gentimicin and corpora irrigation with ciprofloxacin infusion. Serial cavernotomes and Hager\u0026rsquo;s Dilators (maximum of 13mm in diameter) were used to achieve adequate dilatation of the corpora. Postoperatively Intravenous antibiotics were continued for 5days.\u003c/p\u003e \u003cp\u003eThe patients in the second group, who were clinically stable, had the implant insertion at an elective date. They also had a similar retinue of events as in the first group.\u003c/p\u003e \u003cp\u003ePatients were reviewed post-operatively at 48hours, 5days, 2weeks, 6weeks and 3months.\u003c/p\u003e \u003cp\u003eThe case records of patients treated before the commencement of the study [The Retrospective] were retrieved and the required information was extracted. The information was then combined with one obtained from the patients recruited prospectively.\u003c/p\u003e \u003cp\u003eBasic demographic data of the participants, the presenting features, the duration of the symptoms (priapism or erectile dysfunction), previous history and duration of priapism and treatment offered, drugs history [ including intake of herbal concoctions] were recorded for all patients.\u003c/p\u003e \u003cp\u003eIntra-operative findings including duration of surgery, corporal findings, outcome of dilatations, size of implant use, intra-operative complications, and post-operative penile length and complications among others were recorded.\u003c/p\u003e \u003cp\u003eThe information obtained was entered into Excel sheets, refined, grouped and then transferred into SPSS Version 21 and analyzed. Independent t-test and Fisher\u0026rsquo;s exact test were used to assess significance of association. Differences considered statistically significant where p-value was less than 0.05 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 46 patients were recruited into the study with 14 patients into the refractory priapism group and 32 patients into the corporal fibrosis group.\u003c/p\u003e \u003cp\u003eThe age distributions of the patients is as shown in Fig.\u0026nbsp;1with the refractory priapism group having a mean age of 24\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6 years and the corporal fibrosis group of 37\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7 years. The age difference in the 2 groups is statistically significant (t= -4.85, p\u0026thinsp;=\u0026thinsp;0.00002).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure I: Age Distribution of the Patients\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSickle cell disease is the predominant cause of Priapism among our patients as shown in Table\u0026nbsp;1\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable I: Causes of Priapism\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrequency/Percent (n/%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCumulative n/%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefractory priapism\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorporal fibrosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSickle cell disease\u003c/p\u003e \u003cp\u003eUse of aphrodisiacs\u003c/p\u003e \u003cp\u003eHerbal concoctions\u003c/p\u003e \u003cp\u003eidiopathic\u003c/p\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/30.4\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e14/30.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18/39.2\u003c/p\u003e \u003cp\u003e4/8.7\u003c/p\u003e \u003cp\u003e6/13.1\u003c/p\u003e \u003cp\u003e4/8.7\u003c/p\u003e \u003cp\u003e32/69.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32/69.6\u003c/p\u003e \u003cp\u003e4/8.7\u003c/p\u003e \u003cp\u003e6/13.1\u003c/p\u003e \u003cp\u003e4/8.7\u003c/p\u003e \u003cp\u003e46/100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMajority of the patient (73.9%) initially presented with ischaemic priapism while the remaining 27.1% presented with stuttering priapism, and none with non-ischaemic priapism. They most commonly (93.5%) presented after 24 hours of onset of the priapism. Typically, the patients in the first group presented with refractory priapism as shown in Fig II. The most common early management modality for the treatment of acute priapism was found to be intravenous hydration with Normal saline in 47.8%, while 28.7% and 8.7% of the patients had corporal aspiration/irrigation with normal saline\u0026plusmn; adrenaline and shunting procedures respectively. Five patients (10.9%) did not have any form of treatment.\u003c/p\u003e \u003cp\u003eThe IIEF (Domain A= Erectile function) score in all the patients who presented with ED from corporal fibrosis was 1\u0026ndash;10 (severe ED) while this was not applicable for those who presented in acute/stuttering priapism. The intra-operative findings in both groups are as shown in Table II. The duration of the surgery, the length and diametre of the implant used in the 2 groups differ as shown in Table III. In early insertion the typical finding is that of dark venous blood/ necrotic tissues as shown in Fig III.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFig II: Refractory Priapism Fig III:Cavernosal finding in refractory priapism\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable II: Intra-operative Findings\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrequency/Percent (n/%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCumulative n/%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefractory priapism\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorporal fibrosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDark Blood/Necrotic tissues\u003c/p\u003e \u003cp\u003eDark Blood/Corporal Fibrosis\u003c/p\u003e \u003cp\u003eWhole Corporal Fibrosis\u003c/p\u003e \u003cp\u003eProximal Corporal Fibrosis\u003c/p\u003e \u003cp\u003eMultiple sites Fibrosis\u003c/p\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/21.7\u003c/p\u003e \u003cp\u003e4/8.7\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e14/30.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e20/43.5\u003c/p\u003e \u003cp\u003e10/21.7\u003c/p\u003e \u003cp\u003e2/4.4\u003c/p\u003e \u003cp\u003e32/69.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10/21.7\u003c/p\u003e \u003cp\u003e4/8.7\u003c/p\u003e \u003cp\u003e20/43.5\u003c/p\u003e \u003cp\u003e10/21.7\u003c/p\u003e \u003cp\u003e2/4.4\u003c/p\u003e \u003cp\u003e46/100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable III: Duration of Surgery/Dimensions of Implant used\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMean/Standard Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003et- test value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefractory Priapism\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorporal Fibrosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Implant Insertion (minutes)\u003c/p\u003e \u003cp\u003eLength of Implant(cm)\u003c/p\u003e \u003cp\u003eDiameter of Implant(mm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e \u003cp\u003e20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160\u0026thinsp;\u0026plusmn;\u0026thinsp;30\u003c/p\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.5\u003c/p\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-5.69\u003c/p\u003e \u003cp\u003e5.72\u003c/p\u003e \u003cp\u003e7.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e \u003cp\u003e0.0018\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.00001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMajority of our patients had no complications both intra and post- operatively. However, the few complications recorded in both groups were shown in Table IV and V. An implant infection and floppy glans recorded in our patients are shown in Fig IV and V respectively.\u003c/p\u003e \u003cp\u003eAt 3 months follow up, erectile function was re-assessed, 44 patients (95.7%) reported satisfactory erectile function IIEF (Domain A= Erectile function) score of 25\u0026ndash;30.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IV: Intra-operative Complications\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrequency/percent (n/%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefractory Priapism\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorporal fibrosis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorporal Perforation\u003c/p\u003e \u003cp\u003eImplant-Corpora disproportion\u003c/p\u003e \u003cp\u003eUrethral Injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/6.5\u003c/p\u003e \u003cp\u003e2/4.3\u003c/p\u003e \u003cp\u003e1/2.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable V: Post- operative Complications\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eFrequency/percent (n/%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCumulative n/%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRefractory priapism\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorporal fibrosis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFloppy glans\u003c/p\u003e \u003cp\u003eHaematoma\u003c/p\u003e \u003cp\u003eSurgical site infection\u003c/p\u003e \u003cp\u003eImplant Infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003cp\u003e1/2.2\u003c/p\u003e \u003cp\u003e4/8.7\u003c/p\u003e \u003cp\u003e2/4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1/2.2\u003c/p\u003e \u003cp\u003e1/2.2\u003c/p\u003e \u003cp\u003e4/8.7\u003c/p\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/2.2\u003c/p\u003e \u003cp\u003e2/4.3\u003c/p\u003e \u003cp\u003e8/17.4\u003c/p\u003e \u003cp\u003e2/4.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e0.521\u003c/p\u003e \u003cp\u003e0.223\u003c/p\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Fisher\u0026rsquo;s exact test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eFig IV: Implant Infection with distal perforation Fig V: Floppy glans penis\u003c/b\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePriapism though a rare condition is associated with ED that may adversely affect patient psyco-social health. Erectile dysfunction is usually of severe form and results from late presentation or poor treatment of priapism. Penile implant insertion is the gold standard management option for severe ED of varying aetiology. Its use in patients with severe corporal fibrosis following priapism has been reported to be associated with long duration of surgery and high rate of complication. The early insertion of penile implant in patients with priapism may resolve these reported disadvantages. This may be even more indicated in our environment which has high SCD patients burden with high priapism rate [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. From our results majority of the patients are less than 40 years of age. Priapism has been reported to have bimodal peak of incidence between 5\u0026ndash;10 years and 20\u0026ndash;50 years [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Also previous studies from our environment recorded similar age range [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSickle cell disease was the sole cause of priapism among all the patients with refractory priapism and the predominant cause in the corporal fibrosis group. Sickle cell disease has remained the predominant cause of priapism particularly in high SCD burden environment. This is similar to findings in other studies on priapism from the same environment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] but differs from findings of studies from Asia and Europe [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] who have lower SCD burden. In a study in Kano, Nigeria, SCD patients have been shown to have high prevalence of any priapism episode when compared with non SCD patients [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMajority of the patients (93.5%) presented to the hospital after 24hrs of onset of priapism and mostly of acute ischaemic type. Acute ischaemic priapism has been shown to be associated with high rate of ED and this even worsen with long duration (\u0026gt;\u0026thinsp;24hrs) of priapism before any intervention. Late presentation was also attributed to ignorance, feeling of shame, use of herbal preparations and inappropriate counsel by healthcare providers [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Most common interventions our patients had on presentation with priapism were intravenous fluid hydration, analgesics and corporal aspiration (\u0026plusmn;\u0026thinsp;irrigation with epinephrine). Timely corporal aspiration and irrigation with normal saline \u0026plusmn;adrenaline has also been shown to reduce the occurrence of ED following priapism [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Only 37.4% of our patients had corporal aspiration / irrigation or shunts procedure. Late presentation and low practice of corporal aspiration in most of our patients further explained why all the patients in the corporal fibrosis group presented with severe ED, IIEF (Domain A= Erectile function) score of 1\u0026ndash;10. This pattern of treatment for priapism is similar to findings from earlier studies done in the same environment [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This might be attributed to dearth of urologists in the healthcare centres across the region that could provide such interventions.\u003c/p\u003e \u003cp\u003eThe intra-operative findings in the refractory priapism group showed extensive darkening of the corpora with necrotic tissues as a result of ischaemia. A thorough debridement including excision of all brisk areas on the corporal walls until fresh bleeding ensues was an essential step in preventing implant infection among our patients. The corporal fibrosis group showed fibrosis of varying severity depending on duration of the priapism and nature of intervention. Obstruction of the penile venous outflow as typically seen in priapism which leads to stasis of blood within the corpus cavernosum akin to a compartment syndrome, results in the development of hypoxia, acidosis, and glucopenia that results in smooth muscle dysfunction and later fibrosis. The longer the duration of ischaemia the more extensive is the fibrosis [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe duration of the surgery in the two groups was noted to be significantly longer in the corporal fibrosis group owing to difficult dilatation of the corpora due to extensive fibrosis in most of the patients. Adequate corporal dilatation is a key step to successful implant insertion. Dilatation goes serially and guided in order to avoid such complications as corporal perforation hence, takes longer time in severe fibrosis. Similar results were noted by Baher Salman et\u0026rsquo;al in their study [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilarly, both the length and diameter of the implants used in the 2 group shows significant difference. The final length and diameter of the implants used were determined intra-operatively. The refractory priapism group in addition to having a seemingly easier surgery, longer and thicker implants were inserted hence maintaining a better penile anatomy and more satisfactory sexual performance. In the corporal fibrosis group, varying degree of fibrosis narrowed the corporal lumen which in most cases limited the dilatation in length and width hence, a less firmly erect penis was achieved. Also Baher Salman et\u0026rsquo;al obtained similar findings in a previous study in Egypt [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOnly a few of our patients developed complications (intra-operative and post-operative). Complications rate is generally low if standard peri-operative procedures re adhered to. Major complication associated with implants insertion has been implant-related infection which in our patients is comparatively higher in the refractory priapism group (4.8% vs 0%). High Implant infection rate has been reported in patients with acute priapism due to mainly corporal ischaemia and contamination from prior corporal aspiration/shunts [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Few other complications such as urethral injury, corporal perforation and floppy glan were recorded among our patients. Generally, complications are significantly low where standard peri-operative procedures are followed [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eExcept for initial difficulty in penetrative intercourse and glans hypo sensitivity, majority of the patients (95.7%) had satisfactory sexual function 3months after implant insertion. Similar results were reported by Franco P and colleagues [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003ePenile implant insertion in both refractory priapism and corporal fibrosis is effective and safe procedure for the prevention or treatment of ED. While in refractory priapism, insertion is easier and tends to maintain normal penile anatomy, it carried higher infectivity rate particularly when corpora are not properly debrided and irrigated with normal saline and antibiotics. On the other hand, insertion in corporal fibrosis carry longer operation time and difficult dilatation, however, has lower infectivity rate and tends to restore patient lost erectile function though with less firm penis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAKTH- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Aminu kano teaching hospital, Kano\u003c/p\u003e\n\u003cp\u003eED- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Erectile dysfunction\u003c/p\u003e\n\u003cp\u003eEUCR- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Electrolytes, urea and creatinine\u003c/p\u003e\n\u003cp\u003eFBC- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Full blood count\u003c/p\u003e\n\u003cp\u003eICIVAD - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Intracavernosal injection of vasoactive drugs\u003c/p\u003e\n\u003cp\u003eIIEF- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; International index of erectile function\u003c/p\u003e\n\u003cp\u003eIP- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Ischaemic priapism \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePDEI-5 - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 5- phospho di-esterase inhibitors\u003c/p\u003e\n\u003cp\u003ePP - \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Penile prosthesis\u003c/p\u003e\n\u003cp\u003ePPI- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Penile prosthesis insertion\u003c/p\u003e\n\u003cp\u003eSCD- \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Sickle cell disease\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical approval for the conduct of the study was obtained from the Research Ethics Committee (REC) of the AKTH with reference number \u0026ndash;NHREC/28/01/2020/AKTH/EC/3693\u003c/p\u003e\n\u003cp\u003ePatients signed informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability for data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received. The researchers have no affiliation to any of the companies whose products were used in the course of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eMA \u0026nbsp;conceived this research\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMA and SUA were involved in concept development and reviewed existing literature\u003c/li\u003e\n \u003cli\u003eMA entered and later \u0026nbsp;extracted the information of patients from questionnaire\u003c/li\u003e\n \u003cli\u003eMA analysed the data\u003c/li\u003e\n \u003cli\u003eSUL wrote the introduction and discussion\u003c/li\u003e\n \u003cli\u003eAll authors read and agreed with the final manuscript and agreed to present it for publication\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur sincere appreciation goes to the management of Aminu Kano Teaching Hospital, Kano, Nigeria for granting us ethical approval and permission to conduct the study. We also appreciate Drs Abubakar, Suleiman and Aisha all of Department of surgery for their help in printing the questionnaire and retrieving some patients medical records. The medical records department and main operating theatre staff are also appreciated for their contribution to the success of this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHelen RL, Robert LS, Trinity JB. Management of priapism: an update for clinicians. Adv Urol. 2014;6(6):230\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1756287214542096\u003c/span\u003e\u003cspan address=\"10.1177/1756287214542096\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAsif M, David R. Guideline of guidelines: priapism. 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Pattern and Management of Priapism in a Tertiary Hospital of North- Western Nigeria. Cent Afr J Surg. 2017;22(1):66\u0026ndash;71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi.org/10.4314/ecajs.v22i1.9\u003c/span\u003e\u003cspan address=\"10.4314/ecajs.v22i1.9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. COSECSA/ASEA Publication --East.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmit GR, Laith MA, Andrew TG, Gabriel L, Wayne JGH. Role of Penile Prosthesis in Priapism: A Review. World J Mens Health. 2018;36(1):4\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5534/wjmh.17040\u003c/span\u003e\u003cspan address=\"10.5534/wjmh.17040\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEric C. Penile prosthesis implant in the special populations: diabetics, neurogenic conditions, fibrotic cases, concurrent urinary continence surgery, and salvage implant. Asian J Androl. 2020;22:39\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/aja.aja_127_19\u003c/span\u003e\u003cspan address=\"10.4103/aja.aja_127_19\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDechapol B. Penile prosthesis in severe corporal fibrosis: a history of a difficult case using the double corporotomy incision technique. Insight Urol. 2022;43(2):167\u0026ndash;70. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.52786/isu.a.63\u003c/span\u003e\u003cspan address=\"10.52786/isu.a.63\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaher S, Eid E, Mohamed E, Atef B. (2022) Early versus delayed penile prosthesis insertion for refractory ischemic priapism. Arab Journal of Urology1:1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi.org/10.1080/2090598X.2022.2135290\u003c/span\u003e\u003cspan address=\"10.1080/2090598X.2022.2135290\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObi PA, Godspower O, Solomon OO. Impact of Sickle Cell Disease on Affected Individuals in Nigeria: A Critical Review. Int J Gen Med. 2023;16:3503\u0026ndash;15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi.org/10.2147/IJGM.S410015\u003c/span\u003e\u003cspan address=\"10.2147/IJGM.S410015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlagunju OE, Faremi FA, Olaifa O. Prevalence and burden of Sickle Cell Disease among Undergraduates of Obafemi Awolowo University, Ile-Ife. J Community Med Prim Health Care. 2017;29(1):74\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoffi MG, Mawouto F, Djatougbe AA, Etse A, Balakibawi E,Fid\u0026egrave;le CD et\u0026rsquo;al. Management of acute sickle cell priapism in an African (Togo) pediatric department includes conservative measures and intracavernous epinephrine which is safe and efficacious. EJHaem. 2022;3:628\u0026ndash;35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/jha2.440\u003c/span\u003e\u003cspan address=\"10.1002/jha2.440\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarco C, Marco F, Tommaso C, Alessandro P, Andrea C, Roberto La R. Penile Prosthesis Implantation in Refractory Ischaemic Priapism: Patient Selection and Special Considerations. Res Rep Urol. 2022;14:1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003edoi.org/10.2147/RRU.S278807\u003c/span\u003e\u003cspan address=\"10.2147/RRU.S278807\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEric C, Carlo B, Paulo E, Chris L, Daniar O, Sean P. (2022) The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nature Reviews Urology 19:534\u0026ndash;546.\u003cem\u003edoi.org\u003c/em\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e/10.1038/s41585-022-00607-\u003c/span\u003e\u003cspan address=\"http:///10.1038/s41585-022-00607-\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e \u003cem\u003ez\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranco P, Valerio V, Alessandro F, Giorgio G, Fulvio C. Immediate insertion of a soft penile prosthesis as a new option for a safe and cost-effective treatment of refractory ischemic priapism. Archivio Italiano di Urol e Andrologia. 2021;93(3):356\u0026ndash;60. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4081/aiua.2021.3.356\u003c/span\u003e\u003cspan address=\"10.4081/aiua.2021.3.356\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Priapism, Refractory priapism, Corporal Fibrosis, Penile implant","lastPublishedDoi":"10.21203/rs.3.rs-8834822/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8834822/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003ePriapism is a clinical state in which there is persistent usually painful penile erection often in the absence of erotic psychic stimuli or fails to subside despite orgasm. This is a urological emergency which may cause damage to the corporal tissue and ED.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod \u003c/strong\u003eThis was a combined retrospective and prospective study to determine patient presentation and the indications,surgical procedure, limitations and complications of penile implant insertions in patients who presented with priapism sequelae. The subjects were all consenting patients who presented to our hospital with priapism sequelae and who had initial management of the priapism (in our hospital or elsewhere) and eventually had insertion of malleable penile implant in our hospital from January 2017 to June 2024. The records of all the information on the patients was retrieved (and recorded) from our register/electronic records for those included retrospectively while those included prospectively, records were taken as at the time of treatment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eA total of 46 patients were recruited into the study with 14 of them presented in refractory priapism and the 32 presented with corporal fibrosis following poorly treated priapism. The patients were distributed into the 2 groups above and parameters calculated differently to explore any advantage in management of one group over the other. The age distributions differ with the refractory priapism group having a mean age of 24±3.6 years and the corporal fibrosis group of 37±9.7 years (t= -4.85, p= 0.00002). Sickle cell disease was the predominant cause of Priapism (69.6%). On initial presentation, majority (73.9%) had acute ischemic priapism while the remaining 27.1% had stuttering priapism. \u0026nbsp;The intra-operative findings were that of dark blood with necrotic tissues in the refractory priapism group (21.7%) and varying degree of fibrosis in the corporal fibrosis group (69.6%). The duration of the surgery, length and diameter of the implant differ in the 2 groups with a p-value of \u0026lt;0.00001, 0.0018, \u0026lt;0.00001 respectively. Complications recorded include surgical site infection (17.4%), corporal perforation (6.5%) and implant infection (4.3%). Erectile function improved with IIEF score of 25-30 in 95.6% of our patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003ePenile implant insertion in both \u0026nbsp;refractory priapism and corporal fibrosis is effective and safe procedure for the prevention or treatment of ED. A satisfactory sexual function and few or no complications are achieved if standard peri-operative procedures are followed.\u003c/p\u003e","manuscriptTitle":"Penile Implant Insertion in Post Priapism; the Indications, Procedure, Limitations and Complications.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-12 10:47:03","doi":"10.21203/rs.3.rs-8834822/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"219967553830407120987523245846599961253","date":"2026-05-10T16:10:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-10T15:16:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192850054721031065502430263631676598902","date":"2026-05-05T20:04:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T14:28:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128587421144959974591229611000534006703","date":"2026-05-05T12:25:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274863930548421476229950191713526433974","date":"2026-05-04T22:09:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"276460888730063925234765627515767863824","date":"2026-05-03T19:52:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-03T19:28:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-03T19:02:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-24T19:10:37+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-23T21:22:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Urology","date":"2026-04-23T21:18:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-urology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"buro","sideBox":"Learn more about [BMC Urology](http://bmcurol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/buro/default.aspx","title":"BMC Urology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a7a4edf5-87ac-43eb-9fc3-9d02f801e028","owner":[],"postedDate":"May 12th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"219967553830407120987523245846599961253","date":"2026-05-10T16:10:49+00:00","index":45,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-10T15:16:13+00:00","index":44,"fulltext":""},{"type":"reviewerAgreed","content":"192850054721031065502430263631676598902","date":"2026-05-05T20:04:27+00:00","index":43,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T14:28:45+00:00","index":41,"fulltext":""},{"type":"reviewerAgreed","content":"128587421144959974591229611000534006703","date":"2026-05-05T12:25:57+00:00","index":40,"fulltext":""},{"type":"reviewerAgreed","content":"274863930548421476229950191713526433974","date":"2026-05-04T22:09:56+00:00","index":39,"fulltext":""},{"type":"reviewerAgreed","content":"276460888730063925234765627515767863824","date":"2026-05-03T19:52:43+00:00","index":37,"fulltext":""},{"type":"reviewersInvited","content":"14","date":"2026-05-03T19:28:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-03T19:02:18+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-12T10:47:03+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-12 10:47:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8834822","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8834822","identity":"rs-8834822","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}