What question did this study set out to answer?

To illustrate a progressive surgical management strategy for ischemic priapism in a young adult with drug use history.

June 6, 2026

(731) Up All Night: Stepwise Approach to Ischemic Priapism

Key Points

To illustrate a progressive surgical management strategy for ischemic priapism in a young adult with drug use history.
Clinical data were retrospectively collected from the patient's medical records.
Initial treatment included cavernosal aspiration and irrigation, followed by intracavernosal injection of saline with adrenaline.
A distal T-shunt and subsequently a proximal corporospongiosal shunt (Quackles technique) were performed.
Initial treatment included cavernosal aspiration, which confirmed ischemic priapism.
A distal T-shunt was performed but resulted in recurrence; a proximal shunt led to resolution of symptoms.
Intraoperative anticoagulation was administered, and postoperative aspirin reduced recurrence risk.

Abstract

Abstract Introduction Ischemic priapism is a rare urological emergency characterized by a persistent, unwanted erection lasting longer than 4 hours in the absence of sexual stimulation, carrying a high risk of permanent erectile dysfunction. Its management requires prompt diagnosis and a stepwise therapeutic approach, including cavernosal aspiration, irrigation, intracavernosal injection of sympathomimetic agents, and, in refractory cases, surgical shunting. Objective To present a rare case of ischemic priapism in a young adult with a history of regular illicit drug use, illustrating a progressive, multimodal surgical management strategy. Methods Clinical data were retrospectively collected from the patient’s medical records. Results A 29-year-old man with a history of chronic cocaine, crack, and hashish use presented to the emergency department with a 24-hour history of priapism. He reported sildenafil intake the day before symptom onset. Blood gas analysis from cavernosal aspiration confirmed ischemic priapism. Initial percutaneous transglandular aspiration and irrigation with saline were performed, followed by intracavernosal saline with adrenaline (1:100,000) due to early recurrence. Persistent priapism prompted a distal T-shunt, but another recurrence occurred 4 hours later. A proximal corporospongiosal shunt (Quackles technique) was subsequently performed, achieving definitive resolution. Intraoperative anticoagulation with 5,000 IU of unfractionated heparin was administered, and postoperative aspirin was prescribed for 5 days to reduce the risk of recurrence. Conclusions Prolonged ischemic priapism, particularly when associated with combined recreational drug use, may present as a challenging and recurrent condition. Early resolution of the compartment syndrome minimizes corporal tissue necrosis and fibrosis. Refractory and complex cases, such as this one, require a rapid, stepwise, and progressively invasive approach. Mastery of multiple surgical techniques is essential for effective management by the urologist. Disclosure No

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