Permanent Erectile Dysfunction Research Articles

(338) DISPARITIES IN PRIAPISM CARE: INSIGHTS FROM NSQIP DATABASE

Abstract Introduction Priapism, marked by prolonged penile erection unrelated to sexual arousal, carries risks of tissue damage and permanent erectile dysfunction, mainly in its ischemic subtype. Despite guidelines stressing prompt intervention, disparities in management remain largely unexplored, urging further investigation to enhance patient outcomes and quality of life, driving our objective to analyze Priapism data from the National Surgical Quality Improvement Program (NSQIP) database. Objective To examine potential disparities in priapism care using the NSQIP database. Methods We conducted a retrospective analysis of priapism cases from 2007-2021 using the NSQIP database, focusing on ischemic and non-ischemic cases identified through ICD-9 and -10 and CPT codes. We assessed how reported race/ethnicity (Black, Hispanic, White) correlated with 30-day complication rates, surgical interventions (shunting), immediate penile prosthesis (PP) placement, and procedural management (penile injection and irrigation), analyzing p-values with Chi-squared tests. Results Our cohort of 474 priapism patients, were predominately Whites (43%) and the median age was 44 years. Emergent cases accounted for 51.3%, with corporospongiosal shunt being the most common intervention (57.4%). Patient race did not significantly influence the choice of shunting procedure. For those who underwent procedural intervention, 10.6% underwent irrigation of corpora cavernosa and 3.8% underwent injection of corpora cavernosa. Interestingly, Hispanic males trended lower rates in both categories: irrigation (Hispanic 5.6%, Black 10.8%, White 12.9%, p = 0.235) and injection (Hispanic 0%, Black 4.2%, White 5.0%, p = 0.045).Post-operative complications were observed in 6.7% of cases, with blood transfusion being the most common (4.01%). Reoperation rate was 13.7%, primarily for repeat priapism, leading to a 30-day readmission rate of 7.0%. Conclusions Priapism demands swift evaluation and treatment to mitigate discomfort and preserve erectile tissue integrity. Our research suggests a potential link between race and the procedural and surgical approaches to managing priapism, with varying initial management and transfusion rates among racial groups. Future investigations should delve deeper into these racial disparities and investigate potential variations in initial treatment upon presentation to the Emergency Department. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: StreamDx, Inherent Bioscience, Turtle Health, Maimus, Carrot Fertility.

(170) ASSESSMENT OF C-REACTIVE PROTEIN AND PROCALCITONIN VALUES MAY AVOID EXPLANT IN EQUIVOCAL FINDINGS FOR IPP INFECTION

Abstract Introduction Inflatable penile prosthesis (IPP) is the gold standard surgical treatment for erectile dysfunction. IPP infections require device removal and may lead to permanent erectile dysfunction and penile size loss. Infection is a clinical diagnosis made based on the presence of pain, fevers, chills, swelling, redness, tethering and fluctuance or purulence. However, postoperative exam findings may be equivocal, and hematologic testing could help support the need for explanation vs observation in borderline cases. C-reactive protein (CRP), a marker of inflammation, and procalcitonin, a marker of infection, may help to differentiate infection from inflammation. Objective To evaluate whether CRP and procalcitonin can be utilized to avoid explant in the setting of equivocal exam findings in suspected penile prosthesis infection. Methods We retrospectively reviewed records from a single surgeon at a tertiary care center from 2020-2023. Patient were identified if they had exam findings or clinical history concerning for possible IPP infection. Records were then further queried to determine if explant occurred or if the patient was successfully managed nonoperatively. CRP and/or procalcitonin lab values around the time of presentation were obtained and trended, where applicable. CRP and procalcitonin categorical ranges (eg, normal, mild, moderate, marked, or severe elevation), as defined by clinical standards, were compared between groups. Age, Charlson Comorbidity Index (CCI), and IV antibiotic choice at initial surgery were also compared. Fisher’s exact test was utilized to compare categorical outcomes, while independent t-test or Wilcoxon rank sum test were used to compare continuous variables. Results A total of 209 patients (n = 202 virgin cases, 96.7%) received IPP implant during the study period. Of these, 21 (10%) presented with concern for IPP infection with only 5 patients (2.4%) ultimately requiring explanation. When compared to the explanted cohort, patients who were successfully managed nonoperatively had significantly higher frequency of initial normal CRP/procalcitonin, or experienced down trending values (93.75% vs 40%, p = 0.03, Table 1). Negative predictive value of these tests was 71.4%. Age, CCI, and intravenous (IV) antibiotic choice did not differ between groups (Table 1). Conclusions In patients presenting with concern for IPP infection, obtaining and trending procalcitonin and CRP lab values, in concordance with other standard infectious labs such as a complete blood count, may help a urologist determine if a patient truly requires explant. This may be especially true in cases of suspected IPP infection when postoperative signs and symptoms are equivocal. Future, prospective studies are required to determine the predictive value of these laboratory tests in a larger, more diverse population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast Corporation; Boston Scientific.

Targeting heme in sickle cell disease: new perspectives on priapism treatment.

Men with sickle cell disease (SCD) frequently experience priapism, defined as prolonged, painful erections occurring without sexual arousal or desire. This urological emergency can lead to penile fibrosis and permanent erectile dysfunction if not treated adequately. Due to its complex pathophysiology, there is currently no effective preventative treatment for this condition. Recent studies have highlighted the dysfunction of the nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) pathway in erectile tissues as a critical mechanism in developing priapism in SCD. Additionally, further research indicates that intravascular hemolysis promotes increased smooth muscle relaxation in the corpus cavernosum and that excess heme may significantly contribute to priapism in SCD. Pharmacological treatments should ideally target the pathophysiological basis of the disease. Agents that reduce excess free heme in the plasma have emerged as potential therapeutic candidates. This review explores the molecular mechanisms underlying the excess of heme in SCD and its contribution to developing priapism. We discuss pharmacological approaches targeting the excess free heme in the plasma, highlighting it as a potential therapeutic target for future interventions in managing priapism.

Cocaine-related ischemic priapism. Systematic review and presentation of a single center series

IntroductionIschemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing.This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism? MethodsWe conducted a systematic review according to PRISMA guidelines and described our case series. ResultsEight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6 h, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75 h and 2, respectively. ConclusionCocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.

Priapism in a Young Adult With Sickle Cell Disease.

This article presents a case study focusing on priapism in a patient with sickle cell disease, with repeated emergency department (ED) visits and hospitalizations. The patient was successfully identified and treated by the ED nurse practitioner (NP) with aspiration of the corpus cavernosum. Priapism is a persistent penile erection that continues for an extended time. There is some argument about what that length of time is, but generally, the consensus is more than 4 hr beyond sexual stimulation or unrelated to sexual stimulation or sexual interest (Bivalacqua et al., 2022). Priapism is a fairly common but underrecognized complication of sickle cell disease. It represents a urological emergency in which timely diagnosis and appropriate treatment are vital to preserving penile tissue and sexual function. The diagnosis is made clinically with a comprehensive history, physical examination, and appropriate laboratory test values. Initial management can be conservative with hydration and analgesics or, if necessary, more invasive with needle aspiration to promote detumescence. Permanent tissue damage or erectile dysfunction can result if priapism is unrecognized, untreated, or not treated immediately. The NP plays an integral role in treating and preventing permanent damage. Patient education should focus on instructions for preventing priapism and managing episodes at home.

Priapismo isquémico asociado al consumo de cocaína. Revisión sistemática y presentación de una serie de casos de un solo centro

IntroductionIschemic priapism is a medical emergency that, if not treated, could lead to permanent erectile dysfunction. The association between cocaine and priapism is well-known; however, data on patient characteristics, treatment, and outcomes is missing.This work aimed to answer the research question: What are the characteristics, management strategies, and erectile prognosis of patients consuming cocaine and presenting with priapism? MethodsWe conducted a systematic review according to PRISMA guidelines and described our case series. ResultsEight studies were selected for qualitative synthesis, presenting information on ten patients. In our case series, we showed information regarding four patients. From the systematic review, the mean presentation time was 42.6hours, and the mean number of procedures to solve priapism was 2,4; in our case series was 42.75hours and 2, respectively. ConclusionCocaine-related priapism might present with a delayed diagnosis, need more procedures to be managed, and have a worse prognosis. More extensive and prospective studies are required.

Erectile function after different techniques of bulbar urethroplasty: does urethral transection make a difference?

PurposeWe aimed to compare the impact of urethral transection after different techniques of bulbar urethroplasty on erectile function outcome.Materials and methodsWe retrospectively reviewed the records for 245 patients who underwent different urethroplasty techniques for bulbar urethral stricture between February 2013 and January 2021. The comparison between the transecting and non-transecting cohorts included patients’ demographics, clinicopathological features of the urethral stricture, post-urethroplasty erectile function, and success of urethroplasty. Outcomes were erectile function status verified by IIEF5-15 score at preoperative, three months, and 12 months post-surgery. We defined Post-urethroplasty ED as a decrease of 5 points or more.ResultsThe urethroplasty success rate of the entire cohort was 86.9% after a mean follow-up of 45.59 ± 21 months. Out of 245 patients, 18 (7.3%) experienced 90-day complications. Transecting bulbar urethroplasty techniques were performed in 74 patients (30.2%), while non-transecting techniques were performed in 171 patients (69.8%). there were no differences between the cohorts regarding urethroplasty success (87.8% Vs. 86.5%, Mantel-Cox test p = 0.93) or postoperative complications (8.1% Vs. 7%, p = 0.73). Transient ED was evident in the transecting cohort as reported in 8.1% compared to 2.9% for the non-transecting (p = 0.07).Still, but de novo permanent ED was comparable (4.1% Vs. 2.9%, p = 0.65), for transecting and non-transecting, respectively.ConclusionsUnfortunately, some patients who undergo transecting techniques of bulbar urethroplasty experience transient erectile dysfunction that can improve within the first post- urethroplasty year; however, de novo permanent erectile dysfunction is uncommon after different techniques of bulbar urethroplasty and is not predisposed by urethral transection.

(381) Comparing Erectile Dysfunction (ED) Outcomes Following Priapism as an Adverse Effect of Intracavernosal Injectable Medications to Priapism due to Recreational use of Intracavernosal Injectable

Abstract Introduction Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. We previously identified a large portion of ischemic priapism cases presenting to our institution caused by recreational use of intracavernosal injectable medications (ICI) for which patients did not have a prescription. Objective In the present study we identified a nearly equal number of men who presented with ischemic priapism as an adverse effect of ICI for which they did have a prescription. Our goal was to compare erectile function outcomes between these two populations in follow up. Methods Men presenting for ischemic priapism as an adverse effect of prescription ICI from January 2010 to December 2018 were contacted by mail, then via telephone. Standardized questions were asked of all participants on the topic of erectile dysfunction (five-item international index of erectile function (IIEF-5)). IIEF-5 results were compared to our previously described population of men with ischemic priapism caused by recreational use of ICI using the Student’s T-test of means. Results 13 men aged 23 – 68 (mean 51.9) were recruited. Ten men (77%) were white; the remaining three (23%) were black. All men confirmed diagnosis of ED prior to their priapism episodes and all men had their own prescription for ICI from a urologist. Seven men (54%) required phenylephrine irrigation, five (38%) achieved detumescence with cavernosal aspiration and saline irrigation alone, one (8%) required a distal shunt. Mean IIEF-5 for the population at time of phone interview was 12.5 (□ 7.4) signifying mild-moderate ED, which was not significantly different from the mean IIEF-5 of our priapism population due to recreational use of ICI (13.3 □ 4.0; p = 0.87; table 1). Conclusions Men who present with ischemic priapism as an adverse effect of prescription ICI appear to have similar functional outcomes compared to men with ischemic priapism due to recreational use of ICI as assessed by IIEF-5. This could also be interpreted as a better functional outcome considering that this population had pre-existing ED prior to their priapism episode and therefore did not lose erectile function. The adverse effect population also appears to require a shunt in the treatment of their priapism less frequently than the recreational ICI population. Disclosure No

(126) Long-term Functional Outcomes for Men with Priapism Secondary to Recreational Use of Intracavernosal Injectables: A Multi-center Follo- up Study

Abstract Introduction Ischemic priapism is a urologic emergency which results in permanent erectile dysfunction if not managed immediately. There is a dearth of studies evaluating long term erectile function after episodes or treatment for priapism. Objective We evaluated the functional outcomes of a larger, multi-institutional population of men with priapism due to recreational use of ICIs. Methods Men who presented with ischemic priapism due to recreational use of ICIs to Cedars-Sinai Medical Center (Los Angeles, CA), University of California at San Francisco (San Francisco, CA), and Jackson Memorial Hospital (Miami, FL) from January 2010 to December 2018 were contacted via telephone. All participants completed the five-item international index of erectile function (IIEF-5). Results A total of 19 men aged 24 – 59 (mean 47.9) were recruited from the 3 sites. Mean follow up was 77.2 months (+/− 27.6). 17 men (89%) were white; the one man was Asian (5.5%) and one man was Hispanic (5.5%). Seven men (37%) had been diagnosed with ED prior to their priapism episode however none of the men had a prescription for ICIs. Four men (21%) required no intervention at all, eleven men (58%) required phenylephrine irrigation alone, four men (21%) required distal shunting. No men required proximal shunting. None of the men had no ED, 31.6% had mild ED, 36.8% had mild-moderate ED, 26.3% had moderate ED, and 5.3% had severe ED. Mean IIEF-5 for the population was 13.4 (+/− 3.9). Strengths of our study included the large population size give the relative rarity of this condition as well as the geographic diversity of our population. Limitations include our low overall recruitment rate and lack of objective measures of erectile function prior to priapism. Conclusions Men who suffer ischemic priapism secondary to recreational use of ICIs appear to retain some erectile function following their priapism episode. Nevertheless, 100% report some level of ED. This is likely due a combination of adequate erectile function at baseline and expeditious treatment of priapism in a minimally invasive manner. Disclosure No

Don’t jump to conclusion – priapism in acute spinal cord injury: a case presentation

Priapism is an uncommon urology emergency. However, if detected late and not classified correctly and treatment not appropriately given can cause necrosis and fibrosis of penis. This will lead to permanent erectile dysfunction and can be devastating to patient. Literature of Spinal Cord Injury with priapism is rare and not many reported. We have a case of young gentleman with priapism secondary to spinal cord injury. It was detected early and treated promptly and patient had good outcome with no evidence of permanent erectile dysfunction.

Scrutinizing the Therapeutic Promise of Purinergic Receptors Targeting Depression.

Antidepressant use has resulted in a variety of negative consequences, including permanent brain damage and erectile dysfunction. So, the purpose lies in developing something more productive with minimal side effects and consequently improved efficacy. A growing body of evidences indicated a remarkable purinergic signalling system, which helped in dealing with this complication. This has been found to be a powerful formula in dealing with psychiatric disorders. P1 (adenosine), P2X, and P2Y (ATP) are the receptors, involved in the pathology as well as exhibiting the therapeutic action by triggering the purinergic pathway. It was found that A2A and P2X7 receptors specifically were involved and recognized as possible targets for treating depression. Further, the development of biomarkers for the diagnosis of depression has also been attributed to accelerate the process. One such biomarker includes serum uric acid. Many clinical studies reveal the importance of antagonizing P2X7 and A2A receptors, for promising research in understanding the molecular premises of depression. However, further investigations are still needed to be done to open several unfolded mysteries for a better and safe upshot. The selective antagonists for A2A and P2X7 receptors may have antidepressant effects showing positive results, in agreement with non-clinical testing. In this review, efforts are being devoted to the targeted receptors in bringing out antidepressant effects with a possible link involving depression and defined purinergic signalling. Additionally, the overview of various receptors, including their functions and distribution, is being explored in a representative way along with the biomarkers involved.

Review of Ischemic and Non-ischemic Priapism.

Priapism is a rare condition that has different presentations, etiologies, pathophysiology, and treatment algorithms. It can be associated with significant patient distress and sexual dysfunction. We aim to examine the most up-to-date literature and guidelines in the management of this condition. Priapism is a challenging condition to manage for urologists, since the etiology is often multi-factorial and the suggested treatment algorithms are based on small studies and expert anecdotal experience, perhaps due to the rarity of the disorder. Ischemic priapism of less than 24h can be managed non-surgically in most cases with excellent results. Ischemic priapism of more than 36h is frequently associated with permanent erectile dysfunction. Management of prolonged priapism with penile shunting still may result in poor erectile function, so penile prosthesis can be discussed in these scenarios.

Tamsulosin and risk of priapism: A causality assessment using Austin Bradford Hill Criteria.

Tamsulosin hydrochloride, a selective alpha‐adrenergic blocking agent has been previously associated with priapism. Priapism is a medically serious condition that, if not intervened, can cause permanent erectile dysfunction. This study was conducted to investigate whether the association of tamsulosin and priapism is causal. All currently available evidence such as experimental, biological, toxicological, published studies, and safety data mined from the WHO global pharmacovigilance database was systematically organized into the Austin Bradford Hill causality assessment framework. In the international pharmacovigilance database, a strong association between tamsulosin and priapism (IC025 = 4.1; PRR025 = 19.9; ROR025 = 20) was observed. There were 122 cases of priapism associated with tamsulosin submitted to the database from 23 countries. In 87.7% of the cases, tamsulosin was reported as a ‘sole suspect,’ and in 50.8%, it was the only drug administered. In several patients, priapism resolved following discontinuation of tamsulosin and recurred after its reintroduction. Both in the published and unpublished data, for majority of the cases, the time to onset of priapism was within few days following the first intake of tamsulosin. Cases of priapism, particularly those published, were consistent in their clinical features with patients experiencing prolonged painful erection that required aspiration of cavernosal blood, irrigation of the corpora cavernosa, and treatment with vasopressors. Other alpha‐adrenergic blocking agents that are structurally analogous with tamsulosin have also been associated with priapism. In several cases, tamsulosin was used off‐label, for the treatment of ureteral calculi expulsion. Eight patients experienced priapism that ended up with serious complications such as ejaculation disorders and erectile dysfunction. The currently available totality of evidence suggests that the association of tamsulosin and priapism is causal. Healthcare professionals are therefore recommended to cautiously prescribe tamsulosin and ensure that consumers are aware of the potential risk of priapism.

Quality Analysis of YouTube Videos Presenting Pelvic Floor Exercises after Prostatectomy Surgery

Background: Prostate cancer (PC) is a major cause of disease and mortality among men. Surgical treatment involving the removal of the prostate may result in temporary or permanent erectile dysfunction (ED) and urinary incontinence (UI), with considerable impact on quality of life. Pelvic floor muscle training (PFMT) is one of the recommended techniques for the prevention, treatment, and rehabilitation of postoperative complications. The aim of this observational study was to assess the quality of YouTube videos—accessible to any patient—related to exercises after prostatectomy surgery. Methods: A systematic search was performed on YouTube on 24 September 2020. One hundred and fifty videos were selected and analyzed. Two statistical analyses were conducted based on machine-learning techniques, and videos were classified as ‘Relevant’ or ‘Non-Relevant’ using Principal Component Analysis (PCA) models. Two reviewers conducted independent analyses. Inter-observer agreement and individual correlations of video data were evaluated with the Intraclass Correlation Coefficient (ICC). Information quality, reliability, and accuracy were measured using the DISCERN Scale and Global Quality Score (GQS), while video popularity was evaluated using the Video Power Index (VPI). Results: DISCERN scored a mean of 3.35 and GQS scored 3.38. Average number of views was 124,354, mean duration was 14:42 min, mean days online was 1777, mean view ratio was 138.30, mean Likes was 1082, mean Dislikes was 68.58, and mean VPI was 92.28. Conclusions: The quality of the videos available on YouTube regarding the recommended pelvic floor exercises in PC surgery, according to the scores obtained, is High. Educational and health institutions, health professionals, government health authorities, and policy makers need to be involved in the proper development of policies to improve the information available on the web in order to have a positive impact on the healthy behavior of the population.

124 Sex, Drugs, and Ischemic Priapism: Insights into the Culture Surrounding Recreational use of Intracavernosal Injectables in an Urban Population

Ischemic priapism is a urologic emergency resulting in permanent erectile dysfunction if not managed immediately. We previously identified a disproportionate number of men with priapism after recreational use of intracavernosal injectable (ICI) medications without a prescription.

Priapism in Patients with Chronic Myeloid Leukemia (CML): A Systematic Review.

Background:Priapism is defined as a penile erection that persists four or more hours and is unrelated to sexual stimulation. Priapism resulting from hematologic malignancy is most likely caused by venous obstruction from microemboli/thrombi and hyperviscosity caused by the increased number of circulating leukocytes in mature and immature forms. In patients with leukemia, 50% of cases of priapism are due to Chronic Myeloid Leukemia (CML). We present a systematic review of priapism in CML.Acquisition of evidence:An extensive literature research was carried out in PubMed, Google Scholar, SCOPUS, and Science Citation Index databases. The search included cases up to 4th August 2020.Synthesis of evidence:A total of 68 articles were found and included in our review, including 3 reviews from three different centers. We found 68 articles (102 patients; figure 1) and several case reports on priapism in CML. Priapism was noticed in some patients at the first presentation of CML. However, it was infrequently reported during the start of treatment, following the stop of medication and post-splenectomy. The mean age at presentation was 27.4 years, and the mean time from onset of priapism to the time to get medical attention (presentation) was 78.2 hours. The mean white blood cell count associated with priapism was 321.29x109/L, and the mean platelet count was 569 x10 9/L. The chronic phase of CML was the most common phase where priapism occurred. Most patients were Asian (>50%). Nearly a quarter of patients (27.4%) developed permanent erectile dysfunction.Figure 1.The PRISMA flow diagram detailing the cases of chronic myeloid leukemia (CML) presenting priapism.Conclusions:Priapism is a urological emergency requiring urgent multidisciplinary management to prevent erectile dysfunction. Because of the relatively rare occurrence of priapism in CML patients, there is no standard treatment protocol. (www.actabiomedica.it)

A Review of Antipsychotics and Priapism.

Pharmacologically induced priapism is now the most common cause of priapism, with approximately 50% of drug-related priapism being attributed to antipsychotic usage. The majority of pharmacologic priapism is believed to result in ischemic priapism (low flow), which may lead to irreversible complications, such as erectile dysfunction. It is imperative that prescribing physicians be aware of potentially inciting medications. To identify medications, specifically antipsychotics, associated with priapism and prolonged erections and understand the rates and treatment of these side effects. A PubMed search of all articles available on the database relating to priapism, prolonged erections, and antipsychotics was performed. Various typical and atypical antipsychotic drugs (APDs) have been implicated in pharmacologically induced priapism. In addition to dopaminergic and serotoninergic receptors, APDs have affinities for a wide array of other receptors in the central nervous system, including histaminergic, noradrenergic, and cholinergic receptors. Although the exact mechanism is unknown, the most commonly proposed mechanism of priapism associated with APDs is α-adrenergic blockade in the corpora cavernosa of the penis. Priapism appears in only a small fraction of men using medications with α1-receptor-blocking properties, indicating differential sensitivities to the α-blocking effect among men, and/or additional risk factors that may contribute to the development of priapism. The best predictor for the subsequent development of priapism is a past history of having prolonged and painless erections. The acute management algorithm of APD-induced priapism is the same as for other causes of low-flow priapism. Clinicians should educate patients treated with antipsychotics about the potential for priapism and its sequelae including permanent erectile dysfunction. Appropriate patient education will raise awareness, encourage early reporting, and help reduce the long-term consequences associated with priapism through early intervention. Hwang T, Shah T,Sadeghi-NejadH. A Review of Antipsychotics and Priapism. Sex Med Rev 2021;9:464-471.

Priapism in Patients with Chronic Myeloid Leukemia systematic Review of Case Reports

Introduction: Priapism is a persistent penile erection not associated with sexual stimulation lasting for more than 4 hours. It is seen in up to 1.9% of patients with CML in some centers. Priapism adversely affects the quality of life, sexual function, of the affected patients. Long-lasting priapism is associated with a drastic effect on male fertility. The underlying pathophysiology involves disturbed autoregulation of the penile circulation through nitrous oxide (NO) and phosphodiesterase enzyme dysregulation. Method Literature searched in google scholar, PubMed, and Scopus search engines with keywords priapism, chronic myeloid leukemia, chronic granulocytic leukemia, and chronic myelogenous leukemia (English literature between 1960 to 2020) Results One hundred cases of priapism were reported in patients with CML. Most patients were below the age of 40 with mean 27.4years. The youngest was 7 weeks old and the oldest was 60 years old. Most patients had priapism as the first presentation of CM, 3 developed priapism after starting the treatment, 2 after stopping treatment, one noncompliant with treatment,1 previously diagnosed, and 1 patient post-splenectomy. The majority of patients' priapism occurred during the chronic phase of the disease and only 5/100 had priapism during the blast and accelerated phase. They had a mean WBC = 321.29 × 109/ (n=92), and mean platelet count = 569,000 (n=69). The lowest WBC count associated with priapism was 37 x10^9/L, the highest was 782 x10^9/L. Treatment modalities included medications, aspiration and irrigation of the corpora cavernosa, radiation to the penis, leukoreduction, and surgical shunts. Medications were used in (N = 50), aspiration of the corpora cavernosa in (N = 45) patients, leukapheresis in (N = 14), radiotherapy in (N= 9), and shunt in (N = 32). Surgical shunt relieved priapism in (N = 16), another 5 had shunt with partial response and needed chemotherapy to control the priapism. 19 patients responded to aspiration and irrigation, and another 2 required chemotherapy to control priapism. Radiation was helpful in resolving the priapism in 3 patients and Leukapheresis was useful in 5 patients. Medications alone were used to terminate priapism in 10 patients, however, priapism persisted for a longer duration compared to other modalities. It has been known that priapism lasting > 24 hours poses a high risk of permanent erectile dysfunction (94% or more). In 76 of CML patients with priapism, the mean time from onset to the presentation was 78.28 hours (three times longer than the high-risk period). The erectile function was affected in 24/100, not affected in 15/100, and not addressed in 61/100. Conclusion: Although priapism is an uncommon complication of CML, its fast diagnosis and management is crucial to avoid permanent erectile dysfunction. Disclosures No relevant conflicts of interest to declare.

Priapism with Essential Thrombocythemia Review of Literature, Where We Stand and Where We Are Heading

Introduction Priapism is a persistent erection of the penis that is not associated with sexual stimulation or desire lasting more than 4 hours. Priapism can be classified as ischemic, non-ischemic, or stuttering. Stuttering priapism is defined as recurrent priapism lasting less than 4 hours. Commonly, no cause is identified, secondary causes include medications specially intracorporal injections or medical conditions such as hematological diseases particularly sickle cell disease, but it is uncommon to be seen with essential thrombocythemia (ET). It adversely affects the quality of life, sexual function, and physical wellness of the affected patients besides the risk of penile fibrosis and permanent erectile dysfunction. The underlying pathophysiology is not clearly understood but the mechanism involves disturbed nitrous oxide, phosphodiesterase enzyme activity, and disturbed auto-regulation of the penile circulation. Method Literature searched in google scholar, PubMed, and Scopus search engines with keywords priapism, essential thrombocythemia, essential thrombocytosis results found from 1960 to 2020. Results Using the keywords above we found 11 cases of ET devolved or presented with priapism. With the case in our center (not published) the total number of cases will be 12. The cases arranged by chronological order. Almost all age groups are involved from 7 years to 71 years. The table shows hematological parameters, type of mutation, and the management of priapism. Discussion In ET the mechanism of priapism is probably related to high platelet count and platelets sludging in the corpora cavernosa, similar to RBC sludging in sickle cell disease and WBC sludging in leukemia. Subsequent stasis and disturbed NO and cGMP signaling. This might be precipitated by increased viscosity or release of free hemoglobin secondary to hemolysis similar to sickle cell anemia as many patients had low hemoglobin levels (table-1). Looking at the table with the available data most hemoglobin levels are in the lower normal limits, but no patient had high hemoglobin levels, opposite to what can be expected that polycythemia might enhance the viscosity of the blood and enhance thrombosis. Observing other MPN who developed priapism, in one study 430 patients with CML 8 patients developed priapism at diagnosis, they had lower hemoglobin levels compared to CML patients who didn't develop priapism. The mean hemoglobin level in patients with priapism was 8.4 ± 2.3 g/dL, compared to 10.8 ± 2.5 g/dL in CML patients control who didn't develop priapism. To the best of our knowledge, there are no reports of cases of adults with polycythemia Vera who devolved priapism which might indicate that anemia has a synergistic effect with leukocytosis in the pathogenesis of priapism in CML patients. But, it is difficult to generalize this observation to ET. However, anemia can enhance thrombosis and the risk of thromboembolism by different mechanisms not related to reactive thrombocytosis. Some patients presented after years from the onset of priapism. This may indicate the complaint of priapism is underreported especially for patients with stuttering priapism who develop erection for a shorter duration of time and subsides spontaneously. While patients with ischemic priapism have prolonged, painful erection usually seeks medical attention from the first time. This can be the reason that CML reports of priapism are relatively more common 1.9 % compared to ET because CML type is predominantly ischemic. At the same time, ET can be ischemic or stuttering. Most of these cases are reported before 2008 WHO criteria for ET, which explains why no genetic studies done for the cases. This case is the first reported case of CLAR mutation associated with priapism. In the table 6/12 had splenomegaly or splenectomy a ratio close to general ET patients. Conclusion Priapism is a rare presentation and complication of ET. It can present as ischemic or stuttering types. ET with stuttering priapism might be underreported. The main risk factors aren't clear due to old and few reported cases. Splenomegaly, age, and type of mutation appear to have little impact. But the characteristic features are the high platelet count and lower hemoglobin level. Disclosures No relevant conflicts of interest to declare.

Intraoperative application of platelet-rich plasma to the neurovascular bundles during radical prostatectomy: A prospective clinical trial.

TPS380 Background: Radical prostatectomy (RP) is the most common surgical treatment for prostate cancer (PC). Yet even with nerve-sparing RP (NS-RP), a significant proportion of men experience transient or permanent erectile dysfunction (ED) partially due to intraoperative neurovascular bundle (NVB) damage from thermal or mechanical trauma. Studies have shown that platelet released growth factors counteract trauma and facilitate healing. We evaluate the use of platelet rich plasma (PRP) to facilitate early nerve healing and decrease ED after NS-RP. Methods: A prospective, open label, 20 subject human trial evaluating intraoperative topical NVB PRP application was approved by the IRB and FDA under an Investigational Device Exemption (IDE 16915) for the investigational use of an approved blood separation device. Men aged 50-60 with newly diagnosed, localized PC and normal preoperative sexual and urinary function, defined as a Sexual Health Inventory for Men (SHIM) score of >19 and an answer of “none” on question 5 of the Expanded Prostate Cancer Index Composite (EPIC) are eligible. Intraoperatively, a 10ml PRP product is created from a 180 mL sample of the patient’s whole blood using the Angel Concentrated Platelet Rich Plasma System (Cytomedix, Inc., Gaithersburg, MD USA). PRP is applied via mechanical transfer to the NVB after completion of the vesicourethral anastomosis. The primary endpoint is the safety and tolerability of PRP on the NVB after NS-RP. Secondary endpoints include feasibility of intraoperative PRP application and longitudinal assessment of erectile function and urinary continence by questionnaire administration at 3, 6, 9, 12 and 18 months after NS-RP. Clinical trial information: NCT02957149.