[Surgical treatment of priapism: experience of 56 cases in an African setting].
Since priapism is uncommon, treatment is controversial and difficult. In this article we describe a practical, well-documented approach for management of priapism in countries with a high incidence of sickle cell disease. This approach is based on our experience including a total of 56 black patients (49 adults and 7 children) as well as on the results reported in the literature. The patients in our series were examined and treated by the same physician over an 18 year period in various African countries, i.e., Burkina (n = 8), Chad (n = 12), Gabon (n = 19), and Niger (n = 17). Etiologies and pathophysiology are reviewed. In all cases, surgical treatment involved diversion from corpora cavernosa. In the 51 cases with follow-up periods of 3 months or longer, results were considered as excellent in 17 cases (33 p. 100), partial in 5 (9.8 p. 100), and unsuccessful in 29 (56.8). Since 1984, needle drainage with a unilateral transglandular cavernosal-spongiosum shunt based on the technique described by Al Ghorab's has led to better results with immediate detumescence in 80 p. 100 of cases and a long-term success rate of 52 p. 100 (13/25 cases with sufficient follow-up). Except in cases involving sickle cell anemia in which concomitant medical treatment of priapism can be useful, immediate surgical treatment is the only technique effective in avoiding secondary impotence, which was common in our series (58.6). Our p. 100 needle drainage technique appears to be the method of choice for simplified achievement of a unilateral transglandular cavernosal-spongiosum shunt.