Figure 5.

Proximal surgical shunting procedures for ischemic priapism. A Quackels (perineal approach) shunt is created from the corpus cavernosum to the corpus spongiosum at the level of the bulbar urethra where the sponge is most robust and the urethra is relatively further from the shunt. If this procedure is performed from a penoscrotal incision, it is named the Sacher approach. At the penoscrotal junction, the spongiosum surrounding the urethra is thin, increasing the risk of fistula formation.