Recurrent priapism is an uncommon phenomenon of low-flow priapism that leads to cavernous ischaemia with a subsequent damage of erectile function. If episodes lasts longer than 24 hours or occur repeatedly required multiple treatments, this will subsequently lead to patients amassing permanent erectile dysfunction and corporal tissue fibrosis from ischaemia. This case report presents a patient with a recurrent episode of priapism, discuss the treatment choices, and a novel method of a distal shunt.

A comprehensive internet search was conducted to identify all reported case studies, treatment methods and management options for recurrent priapism. Databases including PubMed, Google Schole and the Cochrane library were utilized with the search terms "recurrent priapism", "management of priapism", "treatment options for priapism" and "case reports on idiopathic priapism". Reviewing these case reports and their shunt techniques, they were assessed with regards to patients who represent with stuttering priapism. As a unique clinical presentation, this report aims to also identify potential gaps in current guidelines.

A 42-year-old male presented with recurrent ischaemic priapism episodes over a 20-year interval, with no clear identifiable precipitant. In this scenario, after non-operative measurements such as aspiration and phenylephrine injection are unsuccessful, we proceeded to a new version of a modified winter’s shunt. A modified distal shunt technique, performed as an alternative to the traditional Winter's shunt. Compared to a traditional Winter’s shunt which involves creating a communication channel between the glans and corpora cavernosum with a large biopsy needle, we utilized a balloon dilator to increase the surface area for redirection of ischaemic blood to achieve detumesence. The patient had no recurrence at 6 months, although it is noted that he has not had erectile function since previous episodes.

Recurrent priapism presents a unique management challenge due to its varied etiologies and the limited effectiveness of current medical therapies. This case highlights the successful use of a novel distal shunt technique as an alternative to the traditional Winter’s shunt, offering a potential solution for managing refractory cases. Given the infrequency of such presentations, this approach provides a valuable addition to the existing management repertoire. However, the lack of standardized guidelines underscores the need for further investigation and consensus on treatment protocols. Patients who present with a prolonged asymptomatic period highlights the unpredictable nature of stuttering priapism and the limitations of current treatment protocols.