Low-intensity extracorporeal shock wave therapy (Li-ESWT) for priapism-induced erectile dysfunction in young patients: the first case series

Abstract

Priapism is usually due to a dysfunction of normal erectile physiology involving the mechanisms that regulate initiation/maintenance of penile detumescence [1]. Three types of priapism are described: ischemic (low flow), non-ischemic (high flow), and stuttering (recurrent). Ischemic priapism, often idiopathic, is a persistent erection marked by the rigidity of corpora cavernosa and by little or no cavernous arterial inflow. Non-ischemic priapism, characterized by unregulated cavernous arterial inflow, is often a post-traumatic event. Stuttering priapism, also termed intermittent or recurrent, is a frequent unwanted and painful prolonged erection typically in men affected by sickle-cell anemia (SCD) [2]. Among all these, the more common is the ischemic priapism, accounting for more than 95% of all cases. Its occurrence can be related to several factors as intracavernosal injection of vasoactive medications for erectile dysfunction (ED), phosphodiesterase type 5 inhibitor (PDE5-i), alcohol and recreational drug abuse, medications. In the young and adolescent population, the most frequent form of priapism is due to SCD [2]. Treatments of ischemic priapism should start with therapeutic aspiration, with or without irrigation, followed by intracavernosal injection of a sympathomimetic agent. The correct diagnosis and timely treatment are essential to prevent ischemia and fibrosis of the corpora cavernosa, and the subsequent ED. The treatment approach of ED lowflow priapism-related mainly includes PDE5-I, and intracavernosal injections of vasoactive agents like PGE1, papaverine, and phentolamine. Since medical therapies present a high failure rate, prothesis implantation is often needed [1]. In the last few years, the use of penile low-intensity extracorporeal shock wave therapy (Li-ESWT) has been introduced as a new treatment modality for ED [3–5]. Evidence on the role of Li-ESWT in humans with ED following priapism event are totally missing. The aim of the study is to report data on a case series of patients suffering from ED due to low-flow priapism treated with Li-ESWT.