<p>Penoscrotal decompression (PSD) has emerged as a promising surgical intervention for refractory ischaemic priapism, involving proximal corporotomies and the drainage of ischaemic blood. Initial outcomes have shown high success rates in achieving detumescence, low recurrence rates, and relatively good preservation of erectile function. This meta-analysis aims to comprehensively evaluate PSD’s effectiveness across three key metrics: detumescence, prevention of recurrence, and erectile function preservation. A systematic review and meta-analysis, following PRISMA guidelines, identified 9 publications that met the inclusion criteria. They encompassed five case reports, two abstracts, and two observational cohort studies, with data on 62 patients who presented with refractory ischaemic priapism. Notably, around half (46.7%) of the patients had conventional distal shunts prior to PSD. Overall following PSD, detumescence was achieved in 89.3% (CI 95%, 0.78–0.95). Post-PSD recurrence of ischaemic priapism occurred in 12.7% (95% CI, 0.06–0.24). Erectile function was preserved in 54.8% of the patients who had follow-up (95% CI, 0.40–0.68). These findings inform us that PSD proves to be a viable and effective surgical option for refractory ischaemic priapism with a key feature being better sexual function preservation outcomes compared to shunting procedures. Given the paucity of data, further larger scale prospective studies of robust designs are still necessary to better establish PSD’s role within the treatment algorithm for refractory ischaemic priapism.</p>