TITLE:
Case Series: Early Malleable Penile Prosthesis Implantation via a Mid-Shaft Ventral Incision for Delayed, Refractory Ischemic Priapism Exceeding 72 Hours
AUTHORS:
Abdullah Elrashidy, Gamal Abdelhalim, Mostafa Gaber Menshawy
KEYWORDS:
Ischemic Priapism, Delayed Presentation, Malleable Penile Prosthesis, Ventral Mid-Shaft Incision, Corporal Fibrosis
JOURNAL NAME:
Open Journal of Urology,
Vol.16 No.8,
August
26,
2026
ABSTRACT: Background: Ischemic priapism lasting beyond 48 - 72 hours causes irreversible cavernosal smooth muscle necrosis, severe corporal fibrosis, and profound erectile dysfunction (ED). At this delayed stage, traditional conservative management and distal shunting carry high failure rates and risks of severe tissue loss, prompting consideration of alternative prosthetic options. Case Presentation: We present a case series of two patients presenting with prolonged ischemic priapism (one at 4 days, the other at 7 days post-onset) managed with primary malleable penile prosthesis (PP) implantation. One case was iatrogenically induced by an intracavernosal injection of prostaglandin E1 (PGE1) during a diagnostic penile duplex ultrasound. Both procedures were executed utilizing a mid-shaft ventral incision. Conclusion: In these cases, early malleable implantation within the acute/subacute window resolved the ischemic event, relieved severe ischemic compartment pain, and bypassed the severe technical difficulties associated with delayed prosthetic surgery in a heavily fibrotic penis. The mid-shaft ventral approach offered noted proposed anatomical advantages.