Distal and proximal shunts
A distal shunt is the first choice: a window is created through the head with a thick needle or scalpel at the apex of the corpus cavernosum (Winter, Ebbehoy) or a section of the tunica albuginea under the head is excised (El-Gorab), if necessary, with tunnelization of the corpora cavernosa (T-shunt with dilatation). Blood begins to flow into the corpus spongiosum, and the penis falls off. If the distal shunt does not work, a proximal one is performed: at the root of the penis, the corpus cavernosum is anastomosed with the spongiosum (Quackels) or with the saphenous vein (Greyhack). Both options are priced the same and are combined on this page. After bypass surgery, temporary ED is possible; if priapism lasts longer than 36–48 hours, early penile replacement is discussed.
Priapism - counting the clock
Ischemic priapism is a painful erection lasting longer than 4 hours without stimulation, in which the blood in the cavernous bodies stagnates and the tissues are deprived of oxygen. Causes: overdose of intracavernosal drugs, some psychotropic drugs, sickle cell anemia, leukemia, trauma. After 12 hours, damage to smooth muscles begins, after 24–36 hours - irreversible fibrosis with loss of erection. Treatment in stages: aspiration with the introduction of a vasoconstrictor, then shunting, with prolonged priapism - early penile replacement.
What after treatment
Erectile function is restored in most men who apply within the first 12 hours, and decreases in proportion to the delay. After bypass surgery, temporary ED is possible, which resolves within weeks. The cause must be eliminated: drug doses are adjusted, the underlying disease is treated, and in case of recurrent priapism, prophylaxis is prescribed.
