Priapism is a urological emergency that is defined as a prolonged penile erection lasting more than 4 h, remaining despite orgasm and in the absence of sexual stimulation. Without prompt and complete detumescence, time-dependent changes occur to the smooth muscle of the corpus cavernosa that can result in permanent erectile dysfunction and penile deformity (curvature, shortening and loss of girth). The diagnosis is confirmed with a hypoxic and acidotic blood sample from the corpus cavernosa. The trapped blood inside the corpus cavernosa is aspirated and can be irrigated with 0.9% normal saline. Intracavernosal injection of a sympathomimetic agent is used to cause smooth muscle contraction if the previous measures fail. Failure or recurrence of priapism following these conservative measures is an indication for surgical management. Shunt procedures that create a connection with the corpus cavernosa and a neighbouring structure are often used first line. Multiple shunt procedures have been described and these are summarised in this article. Distal shunt procedures are the most commonly used as they are easier to perform and seem to have at least comparable detumescence and potency rates. Refractory or prolonged (>48 h) ischaemic priapism maybe an indication of immediate placement of a penile prosthesis.

中文翻译：

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缺血性阴茎异常勃起的外科治疗。

阴茎异常勃起是一种泌尿外科急症，被定义为阴茎勃起持续超过4小时，尽管性高潮和没有性刺激，但仍持续存在。如果没有迅速而完全的消肿，海绵体的平滑肌会发生随时间变化的变化，这可能导致永久性勃起功能障碍和阴茎畸形（曲度，缩短和丢失环周）。通过来自海绵体的低氧和酸中毒血样证实了诊断。吸出海绵体内的残留血液，可以用0.9％的生理盐水冲洗。如果先前的措施失败，则使用海绵体腔内注射拟交感神经药来引起平滑肌收缩。这些保守措施导致的阴茎异常勃勃手术失败或复发是外科治疗的指征。第一行通常使用与海绵体和邻近结构建立连接的分流程序。已经描述了多种分流过程，本文对此进行了总结。远端分流术是最常用的，因为它们更易于执行，并且似乎至少具有可比的消肿和有效率。难治性或长时间（> 48小时）的缺血性阴茎异常勃起可能提示立即放置阴茎假体。