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The efficacy of penoscrotal decompression for refractory ischaemic priapism: a systematic review and meta-analysis

International Journal of Impotence Research (2025)Cite this article

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Abstract

Penoscrotal decompression (PSD) has emerged as a promising surgical intervention for refractory ischaemic priapism, involving proximal corporotomies and the drainage of ischaemic blood. Initial outcomes have shown high success rates in achieving detumescence, low recurrence rates, and relatively good preservation of erectile function. This meta-analysis aims to comprehensively evaluate PSD’s effectiveness across three key metrics: detumescence, prevention of recurrence, and erectile function preservation. A systematic review and meta-analysis, following PRISMA guidelines, identified 9 publications that met the inclusion criteria. They encompassed five case reports, two abstracts, and two observational cohort studies, with data on 62 patients who presented with refractory ischaemic priapism. Notably, around half (46.7%) of the patients had conventional distal shunts prior to PSD. Overall following PSD, detumescence was achieved in 89.3% (CI 95%, 0.78–0.95). Post-PSD recurrence of ischaemic priapism occurred in 12.7% (95% CI, 0.06–0.24). Erectile function was preserved in 54.8% of the patients who had follow-up (95% CI, 0.40–0.68). These findings inform us that PSD proves to be a viable and effective surgical option for refractory ischaemic priapism with a key feature being better sexual function preservation outcomes compared to shunting procedures. Given the paucity of data, further larger scale prospective studies of robust designs are still necessary to better establish PSD’s role within the treatment algorithm for refractory ischaemic priapism.

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Author information

Authors and Affiliations

  1. Health Education England North East Deanery, Newcastle upon Tyne, UK

    Mohamed Mubarak & John Hayes

  2. Government Hospital, Manama, Kingdom of Bahrain

    Qasim Isa

  3. Manchester University Hospitals NHS Foundation Trust, Manchester, UK

    Ian Pearce & Vaibhav Modgil

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  1. Mohamed Mubarak
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  2. Qasim Isa
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  3. John Hayes
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  4. Ian Pearce
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  5. Vaibhav Modgil
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Contributions

MM: Study Conception & Design, Data Collection & Analysis, Manuscript Writing & Editing. QI: Study Conception & Design, Data Collection, Manuscript Writing. JH: Data Collection, Manuscript Writing & Editing. VB: Supervision, Manuscript Writing & Editing, Approval of Final Version. IP: Supervision, Manuscript Writing & Editing, Approval of Final Version.

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Correspondence to Mohamed Mubarak.

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Mubarak, M., Isa, Q., Hayes, J. et al. The efficacy of penoscrotal decompression for refractory ischaemic priapism: a systematic review and meta-analysis. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01044-3

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