Surgical Management of Ischemic Priapism Consent

Informed Consent For Surgical Operation / Procedure

Procedure: Surgical Management of Ischemic Priapism

1. Patient Identification

I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):

Procedure: _______________________________
Diagnosis: ________________________________
Major illness & comorbidities: ________________________________

2. Authorization for Procedure

I authorize Dr. __________________ to perform the above procedure, along with such assistants and associates as may be selected by him/her.

I understand that members of the surgical team, including residents or trainees under appropriate supervision, may perform parts of the procedure according to their training and competence.

3. Nature of Procedure

I consent to undergo emergency surgical treatment for ischemic priapism, including one or more corporal shunt procedures, and any additional procedures that may become necessary to preserve penile tissue, control bleeding, or ensure my safety.

The procedure is performed under general, spinal, or regional anaesthesia.

Depending on my condition, the surgeon may perform one or more of the following procedures:

1. Distal Corporoglanular Shunt

A small opening is created between the glans penis and the corpora cavernosa to allow trapped blood to drain.

Possible techniques include:

  • Winter shunt
  • Ebbehoj shunt
  • T-Shunt
  • T-Shunt with corporal tunnelling
  • Al-Ghorab shunt

The exact technique will be selected according to the severity and duration of priapism and the surgeon’s judgment.

2. Corporal Tunnelling

If thick clotted blood prevents adequate drainage, a dilator or instrument may be passed within the corpora to remove obstructing thrombus and facilitate decompression.

3. Proximal Shunt

If distal shunt procedures fail to relieve the priapism, a proximal shunt, such as the Quackels procedure, may be required to create an alternative drainage pathway.

The decision to proceed to a proximal shunt will be made intraoperatively if clinically indicated.

4. Benefits and Indications

The procedure may be required for:

  • Acute ischemic (low-flow) priapism
  • Recurrent (stuttering) ischemic priapism
  • Persistent ischemic priapism after failed aspiration and intracavernosal medication

The expected benefits include:

  • Relief of painful prolonged erection
  • Decompression of the corpora cavernosa
  • Restoration of blood flow
  • Prevention of further ischemic injury
  • Reduction in corporal fibrosis
  • Improved chance of preserving penile structure

I understand that the likelihood of preserving erectile function decreases significantly as the duration of ischemic priapism increases, particularly beyond 24–36 hours.

I understand that after 36–48 hours, many patients develop irreversible corporal smooth muscle damage despite technically successful surgery.

5. Risks and Complications

Although every effort is made to minimize complications, I understand that the following complications may occur.

Common Complications (>5%)

ComplicationReported Frequency
Permanent erectile dysfunction30–90%*
Persistent corporal fibrosis (scarring)20–80%
Failure of initial shunt / persistent priapism10–30%
Recurrent priapism5–20%
Penile edema (swelling)10–40%
Penile bruising (ecchymosis)10–30%
Postoperative penile pain10–30%
Penile shortening due to fibrosis10–40%
Need for repeat shunt procedure5–20%
Need for penile prosthesis because of irreversible ED20–60% (especially when priapism exceeds 36–48 hours)

*The incidence of erectile dysfunction increases dramatically as the duration of ischemic priapism increases.

Less Common Complications (1–5%)

ComplicationReported Frequency
Wound infection1–5%
Hematoma2–10%
Persistent wound drainage1–3%
Delayed wound healing1–5%
Urinary retention1–3%
Glans sensory changes/numbness2–10%
Cosmetic dissatisfaction2–5%
Bleeding requiring return to theatre1–3%
Residual painful erection2–5%

Uncommon Complications (0.1–1%)

ComplicationReported Frequency
Urethral injury<1%
Corporal perforation<1%
Injury to dorsal nerves or vessels<1%
Skin necrosis<1%
Glans ischemia<1%
Urethrocutaneous fistula<1%
Permanent glans numbness<1%
Chronic neuropathic penile pain<1%

Rare Complications (<0.1%)

ComplicationReported Frequency
Glans necrosis requiring reconstruction<0.1%
Severe uncontrolled hemorrhage<0.1%
Deep vein thrombosis (DVT)<0.1%
Pulmonary embolism<0.1%
Myocardial infarction or stroke related to anaesthesia<0.1%

6. Postoperative Course

I understand that I should:

  • Keep the dressing clean and dry.
  • Take prescribed medications.
  • Avoid sexual intercourse for 6–8 weeks.
  • Avoid heavy lifting for approximately four weeks.
  • Attend scheduled follow-up visits.
  • Report immediately if I develop fever, severe pain, bleeding, wound discharge, inability to pass urine, increasing penile swelling, or black discoloration of the penile skin.

7. Alternatives to Procedure

I understand that ischemic priapism is a urological emergency and that delay in treatment may lead to permanent erectile dysfunction and irreversible penile damage.

8. Anaesthesia and Pain Management

I understand the risks associated with local, regional, or general anaesthesia.

Pain management options have been explained.

9. Photography / Data Use

I consent to:

☐ Medical photography/video for academic purposes

☐ Use of anonymized clinical data

10. Intraoperative Decision Consent

I authorize the surgeon to perform additional procedures considered necessary if unexpected findings arise during surgery.

11. Team-Based Care

I understand that supervised residents, fellows, or assistants may participate.

12. Patient Statement

I confirm that:

  • The nature of surgery has been explained.
  • Risks, benefits, and alternatives have been explained.
  • My questions have been answered satisfactorily.
  • I voluntarily consent.

Patient to write in own handwriting:

“I have understood the procedure, risks, benefits and alternatives explained to me in a language I understand.”

Signatures

Patient Name & Signature: ______________________________________

Date: ____________________ Time: ____________________

Doctor Name & Signature: ______________________________________

Date: ____________________ Time: ____________________

Witness Name & Signature: ____________________________________

Contact No.: ______________________________

ATTENDANT CONSENT (If applicable)

Reason patient unable to consent:

Attendant Name: __________________________________________

Relationship: _____________________________________________

Signature: ________________________________________________

Contact No.: ______________________________________________

INTERPRETER STATEMENT (If applicable)

I confirm an accurate explanation in understandable language.

Name: _________________________________________________

Signature: ______________________________________________

Contact: ________________________________________________

HIGH-RISK CONSENT (If applicable)

High-risk factors explained due to:

Patient Signature: ________________________________________

Doctor Signature: _________________________________________

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