The hallmark of refractory ischemic priapism (RIP) is increasing tissue necrosis and hypoxia due to blocked venous outflow caused by unrelieved tissue pressure inside a confined compartment. inside six hours of start, irreversible changes to corporal tissue take place as a result of RIP, which causes time-dependent alterations inside the corpora cavernosa. While 50% of patients can maintain their erectile function if their priapism is treated within 24 hours, the maintenance of erectile function and the response rate to distal shunt procedures progressively decrease as priapism lengthens. Guidelines from the American Urological Association state that once more conservative methods have failed, a distal penile shunt surgery is usually part of the management of RIP. Distal shunts, such as intracavernosal tunneling, have poor results for protracted ischemic priapism, with just 30% of priapic episodes lasting more than 48 hours successfully treated. Penoscrotal corporal decompression is a simple technique in the management of RIP with fewer complications & less cost with the restoration of erectile function than other techniques. PSD has favorable results in maintaining adequate sexual function as If PSD does not produce a long-lasting new shunt from the corpora cavernosa to the glans or spongiosum, there may be a greater chance of restoring physiological erectile function.