Editing Priapism (section)

===== Priapism refractory to shunting =====
*'''<span style="color:#ff0000">A vascular study (such as a PDUS) or cavernosal blood gas should be performed prior to performing additional interventions (repeat distal or proceeding to proximal shunting).</span>[https://pubmed.ncbi.nlm.nih.gov/35536142/ ★]'''
**Goal is to assess penile hemodynamic characteristics and extent of necrosis/fibrosis to differentiate persistent acute ischemic priapism from reactive hyperemia or conversion to non-ischemic priapism and inform secondary treatment decisions
***Penile corporal blood gas can help with decision making about proceeding to additional surgical procedures including placement of an immediate penile prosthesis.
***Penile duplex ultrasound 
****Can be used to 
*****Differentiate between acute ischemic and non-ischemic priapism
*****Determine shunt patency by showing restoration of cavernosal arterial inflow in a patient who has undergone a distal shunt
**Further surgical decisions should not be based only on exam
**'''Evaluating the status of a patient with refractory priapism is particularly important in the event that a patient is referred from another institution and/or the clinician is seeing a patient who had been previously treated elsewhere and a complete patient history may not be available.'''