(207) Risk for Priapism after Intracavernosal Injections and Selected Treatments after Index Priapism Encounters

Abstract

Abstract Introduction Priapism remains a challenging consult for urologists. Proper understanding of the risk of priapism after intracavernosal injections (ICI) and management trends for patients with priapism may help urologists facing this issue. Objective To describe rates of priapism and patient demographics after ICI and management trends after a diagnosis of priapism using a global database. Methods TriNetX is a collaborative research enterprise which collects real-time data from almost 89 million patients located in 58 healthcare organizations across the globe and analyzes patient data from 20 years back to present (2002-2022). We queried TriNetX for all adult patients receiving ICI or presenting for priapism, using Common Procedural Terminology (CPT) and International Classification of Diseases-10 (ICD-10) codes. The index event was defined as usage of ICI or incidence of priapism. We performed descriptive statistics to describe rates of priapism after ICI within 3 days and between 4 and 90 days after injection and described demographic differences between patients presenting with priapism after ICI and those who did not. We evaluated treatment options for priapism at 1 week, 90 days, 1 year, and 5 years after the initial event. We also described rates of additional priapism episodes within 1 year and 5 years after index priapism encounter. Analyses were run on June 28th, 2022. Results There were 26104 usages of ICI and 17545 recorded instances of priapism. Of patients receiving ICI, 4% and 1.6% had priapism at 3 days and between 4 and 90 days, thus most patients presented with priapism near-immediately. Patients presenting with priapism after ICI tended to be younger (46.4 years vs 57.4 years, p<0.01) and had a disproportionate prevalence of mood disorders (20% vs 14%, p<0.01), pain disorders (16% vs 12%, p<0.01) and sickle cell disease (6% vs <1%, p<0.01). They were less likely to have comorbidities such as diabetes (14% vs 22%, p<0.01), hypertension (33% vs 40%, p<0.01) or a history of prostate cancer (13% vs 25%, p<0.01) and less likely to have taken phosphodiesterase 5 inhibitors such as sildenafil (30% vs 35%, p<0.01) or tadalafil (29% vs 38%, p<0.01) in the past. The most common treatment for priapism was irrigation and/or injection of medications (11.3% same day, Table 1). The prevalence of implants for patients experiencing priapism steadily increased throughout the various timepoints, but overall remained low. Conclusions Priapism remains an infrequent problem that is difficult to study given the relative rarity of presentation. By utilizing a global data set, we are to describe rates of priapism after ICI and treatments for priapism. For patients prescribed ICI, proper counseling of the risks of priapism is important to reduce damaging long term consequences if the condition does occur. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.