Corpora cavernosa decompression by progressive dilation for long standing acute low flow priapism

D. K. Osmonov, B. Hazir, A. S. Merseburger, M. Roesch, A. M. Ragheb

Priapism, decompression, penoscrotal, ischemic, corporal, fibrosis

This surgical video demonstrates penoscrotal decompression (PSD) using progressive corporal dilation as a safe and effective approach for refractory ischemic priapism. A 52-year-old male presented after 74 hours of priapism unresponsive to aspiration, irrigation, and shunting. Through a penoscrotal incision, bilateral corporotomies enabled active clot evacuation using progressive dilation with Brooks dilators, followed by suction and heparinized saline irrigation. Complete decompression was achieved without complications. Unlike passive expression techniques, this method ensures thorough hematoma clearance and improved corporal decompression. PSD offers a controlled, reproducible option when conservative measures fail and may serve as a bridge to future penile prosthesis implantation in select cases. This step-by-step video highlights the practical benefits of combining active clot extraction with progressive dilation for optimized outcomes in prolonged low-flow priapism.

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