Presentation duration, non-operative detumescence and operative management in ischaemic priapism

Abstract Presentation duration may influence non-operative treatment success in ischaemic priapism. This retrospective study analysed 63 episodes managed by corporal aspiration with or without intracavernosal phenylephrine. The primary outcome was successful non-operative detumescence; secondary outcomes were operative management and readmission. Outcomes were compared using a 24-h threshold and continuous logistic regression adjusted for previous priapism. Detumescence occurred in 39/63 episodes (61.9%) and operative management in 19/63 (30.2%). Within versus after 24 h, detumescence was more frequent (82.5% versus 26.1%; p < 0.001) and operative management less frequent (12.5% versus 60.9%; p < 0.001). Each 6-h delay increased the odds of failed detumescence (OR 1.35, 95% CI 1.13–1.62; p < 0.001) and operative management (OR 1.27, 95% CI 1.09–1.48; p = 0.002). Presentation duration discriminated failed detumescence (AUC 0.828, 95% CI 0.721–0.935) and operative management (AUC 0.794, 95% CI 0.669–0.919). An exploratory 28-h threshold identified failed detumescence with 70.8% sensitivity and 84.6% specificity and operative management with 73.7% sensitivity and 79.5% specificity. Delay was not independently associated with readmission. Increasing presentation duration was strongly associated with non-operative treatment failure and operative management. Presentation after 24 h sharply reduces successful non-operative detumescence and increases the need for surgery, supporting urgent referral and treatment.