Comparative Outcomes of Early versus Delayed Penile Prosthesis Insertion in Patients With Ischaemic Priapism—Long‐Term Outcome Experience From a Single High‐volume Centre

BACKGROUND AND OBJECTIVES: Ischaemic priapism (IP) is a urological emergency that can lead to erectile dysfunction (ED) if not treated promptly. This study aims to evaluate and compare clinical outcomes between early and delayed penile prosthesis insertion in patients with IP. METHODS: This is a single centre retrospective observational study, which included 166 patients who underwent penile prosthesis surgery for refractory IP from 2006 to 2025. Data were collected through institutional databases. KEY FINDINGS AND LIMITATIONS: Early prosthesis insertion was performed in 112 patients, with a median time (IQR) to implantation of 10 (6-15) days. 54 patients underwent delayed insertion, with a median time of 270 (120-1460) days. In unadjusted analysis, patient satisfaction was higher in the early group (OR 2.93; 95% CI: 1.21-7.18); however, this became a non-significant trend after multivariable adjustment for prosthesis type. Delayed implantation remained independently associated with higher odds of revision surgery after adjustment for prosthesis type (OR 3.74; 95% CI: 1.22-11.44) There were no statistically significant differences between reported penile shortening and post-operative infection. Key limitations include the study's retrospective single-centre design, differential follow-up duration and the lack of a standardized questionnaire to assess patient satisfaction. INTERVENTIONS: Patients in both early and delayed group underwent penile prosthesis implantation, either a malleable or inflatable prosthesis was used. CONCLUSIONS AND CLINICAL IMPLICATIONS: The findings from this study highlight the importance of timely management of IP in clinical settings. Early penile prosthesis insertion is associated with lower revision risk and demonstrates a trend toward improved satisfaction. The findings support a proactive surgical approach towards patients with refractory IP, underscoring the importance of prompt management when conservative treatment fails.