MP78-16 PROBABILITY OF SHUNTING FOR ISCHEMIC PRIAPISM BASED ON ETIOLOGY: ROLE FOR PATIENT EDUCATION

Abstract

You have accessJournal of UrologySexual Function/Dysfunction: Evaluation II (MP78)1 Apr 2020MP78-16 PROBABILITY OF SHUNTING FOR ISCHEMIC PRIAPISM BASED ON ETIOLOGY: ROLE FOR PATIENT EDUCATION Ethan Matz*, Rahul Dutta, William Anderson, Kyle Scarberry, and Ryan Terlecki Ethan Matz*Ethan Matz* More articles by this author , Rahul DuttaRahul Dutta More articles by this author , William AndersonWilliam Anderson More articles by this author , Kyle ScarberryKyle Scarberry More articles by this author , and Ryan TerleckiRyan Terlecki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000964.016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Refractory ischemic priapism (IP) often requires shunting. We hypothesize cases due to sickle cell (SC) disease or prescribed intracavernosal injection (ICI) may present earlier. We sought to characterize etiology and management for IP to determine likelihood of shunting based on patient parameters. METHODS: An IRB approved database of men seen for IP at our emergency department (ED) since January of 2011 was reviewed. Case data through December 2018 was evaluated for demographics and event details. For patients with recurrent IP, the most recent event was considered. Statistical associations were assessed with chi square and 2-sided t-test, and ROC analysis performed. RESULTS: In total, 110 men were included. Median overall time to presentation (TTP) to ED for IPP was 10 hours (1.5-196). Etiologies included: ICI (24%), idiopathic (16%), trazodone use (16%), SC trait or disease (15%), use of other psychotropic medications (15%). Other etiologies comprised an insignificant number of cases. Median TTP for SC and ICI were not significantly different with median of 6.5 (1.5-22) and 6 (3-120) hours, respectively (p = 0.42).Likelihood of undergoing shunt surgery was highest among cases due to psychotropic medication (59%), followed by trazodone (44%), idiopathic (38%), and ICI (8%). No SC patients required shunting.When compared directly to ICI, the odds of shunting were significantly higher for idiopathic (OR 7.6 CI 1.35, 42.89 p=0.02) or trazodone-related cases (OR 9.6 CI 1.72, 53.4 p=0.0098). ROC analysis yielded a sensitivity of 1 and specificity of 0.9231 for requiring distal shunt using 20 hours to presentation as a cutoff (AUC=0.9904, p<0.0001). No men presenting sooner had distal shunting, while 84% of those seen after were shunted.Grouping SC and ICI cases together (42 men, 38% of cohort), rate of shunting was 4.8% vs 44.1% in others combined (p < 0.001). Median TTP for SC and ICI combined was 6 (1.5-120) hours vs 17 (2-196) hours for others combined (p = 0.001) CONCLUSIONS: Cases of IP presenting to the ED are most commonly due to ICI, and these cases typically present earlier and have a lower incidence of shunting. IP secondary to trazodone or other oral medications presents later with a significantly higher chance of surgery. TTP beyond 20 hours is unlikely to avoid shunting. Analysis for SC and ICI cases suggest lower likelihood of surgery is due to earlier TTP, possibly secondary to better education regarding risk of IP. Prescribers offering trazodone or psychotropic medications associated with IP may need to better educate patients on risk. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1179-e1179 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ethan Matz* More articles by this author Rahul Dutta More articles by this author William Anderson More articles by this author Kyle Scarberry More articles by this author Ryan Terlecki More articles by this author Expand All Advertisement PDF downloadLoading ...