Abstract Introduction Corporal decompression is the first-line surgical intervention for refractory low-flow priapism per EAU guidelines. However, the optimal technique for effective clot evacuation remains under debate. Objective In this surgical video, we present a step-by-step demonstration of penoscrotal decompression (PSD) for low-flow priapism using active clot extraction and progressive dilation. Methods A 52-year-old male presented 74 hours after onset of ischemic priapism, refractory to aspiration, irrigation, and a Winter shunt. A penoscrotal approach was used to expose the corpora cavernosa. Bilateral corporotomies were performed, and a biopsy obtained. Progressive proximal and distal corporal dilation was carried out using Metzenbaum scissors and Brooks dilators. Hematoma evacuation was facilitated with a pediatric Yankauer suction. Irrigation with heparinized saline was followed by standard closure and drain placement. Results Complete evacuation of clotted blood was achieved. The procedure was completed without complication. Conclusions PSD is a safe and effective technique for refractory ischemic priapism. Active clot evacuation via progressive dilation may improve outcomes over passive manual expression alone. PSD is a viable option following failure of conservative interventions and may serve as an alternative for or a bridge to potential definitive management via future penile prosthesis implantation in selected patients.
Ragheb et al. (2026) studied this question.