Priapism: treatment and results, based on a personal series of 56 cases

Objectives : To define based on the author's experience and the data of the literature, a simple and rigorous practical approach to the management of priapism in developing countries, for which the therapeutic approach is con troversial and difficult due to the rarity of this condition. Material and Methods : The reported series is based on 56 cases of priapism in black patients (49 adults and 7 children), observed and treated by the same operator over an 18-year period in Burkina (n=8) and then in Chad (n=1 2), Gabon (n=19) and Niger (n=17). The pathophysiology and aetiologies are reviewed. Results : All patients treated surgically underwent various surgical techni ques for diversion of the corpora cavernosa. In this group of 51 reported c ases, there were 17 successes (33.3%), 5 partial results (9.8%) and 29 fail ures (56.8%). The overall immediate success rate, resulting in detumescence was 36/51 (70%). These initial successes almost exclusively concerned pati ents treated by unilateral cavernoglandular shunt within an interval not ex ceeding 2 days. Although the long-term results, all treatments combined were disappointing (56.8% of patients with sufficient follow-up are impotent), creation of a u nilateral cavernoglandular fistula to the glans, based on Al Ghorab's techn ique appeared to provide the best results with a success rate of 52%, i.e. 13/25 cases of priapism correctly followed. Conclusion : Except in the context of sickle-cell anaemia in which concomit ant aetiological treatment can be proposed, only emergency surgery is effec tive to avoid secondary impotence. The unilateral cavernoglandular shunt is extremely simple and, according to the author remains the best procedure.