Topical Nitroglycerin Research Articles

Effect of Topical Iloprost and Nitroglycerin on Gastric Microcirculation and Barrier Function during Hemorrhagic Shock in Dogs

Background: Topical drug application is used to avoid systemic side effects. The aim of this study was to analyze whether locally applied iloprost or nitroglycerin influence gastric mucosal perfusion, oxygenation, and barrier function during physiological and hemorrhagic conditions. Methods: In repeated experiments, 5 anesthetized dogs received iloprost, nitroglycerin, or normal saline during physiological and hemorrhagic (-20% blood volume) conditions. Macro- and microcirculatory variables were recorded continuously. Gastric barrier function was assessed via translocation of sucrose into the blood. Results: During hemorrhage, gastric mucosal oxygenation decreased from 77 ± 4 to 37 ± 7%. This effect was attenuated by nitroglycerin (78 ± 6 to 47 ± 13%) and iloprost (82 ± 4 to 54 ± 9%). Sucrose plasma levels increased during hemorrhage from 7 ± 4 to 55 ± 15 relative amounts. This was alleviated by nitroglycerin (5 ± 8 to 29 ± 38 relative amounts). These effects were independent of systemic hemodynamic variables. Conclusions: During hemorrhage, topical nitroglycerin and iloprost improve regional gastric oxygenation without affecting perfusion. Nitroglycerin attenuated the shock-induced impairment of the mucosal barrier integrity. Thus, local drug application improves gastric microcirculation without compromising systemic hemodynamic variables, and it may also protect mucosal barrier function.

Mastectomy skin flap necrosis: challenges and solutions.

IntroductionMastectomy skin flap necrosis (MSFN) has a reported incidence of 5%–30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions.MethodsA MEDLINE search was performed using the search term “mastectomy skin flap necrosis”. Titles and abstracts from peer-reviewed publications were screened for relevance.ResultsMSFN is a common complication and may present as partial- or full-thickness necrosis. Predictive patient risk factors include smoking, diabetes, obesity, radiotherapy, previous scars and severe medical comorbidity. MSFN leads to a number of challenges, including wound management problems, delays to adjuvant therapy, esthetic compromise, implant extrusion, patient distress and financial loss. Careful preoperative planning and meticulous surgical technique may reduce the incidence of MSFN. A number of intraoperative techniques are available to try and predict skin flaps at risk of MSFN. MSFN may be managed operatively or nonoperatively. Early intervention may reduce the morbidity of MSFN in selected cases. Topical nitroglycerin ointment may be beneficial in reducing MSFN following immediate reconstruction, but the evidence base is still limited.ConclusionMSFN can result in considerable challenges for the patient and the health care service. This review discusses the management options for this problem.

Regional to the Rescue! Axillary Brachial Plexus Nerve Block Facilitates Removal of Entrapped Transradial Catheter Placed for Cardiac Catheterization

Our objective was to describe the first reported use of an axillary brachial plexus block to treat the entrapment of a transradial artery catheter due to vasospasm. A 42-year-old man undergoing transradial arterial cardiac catheterization suffered arterial vasospasm causing the catheter to become entrapped and refractory to conservative (warm compresses) and standard pharmacologic interventions (intracatheter verapamil, intravenous infusions of nitroglycerin and nicardipine, and subcutaneous lidocaine and topical nitroglycerin). Anesthesia was consulted, and attempts at catheter removal under monitored anesthesia and general anesthesia failed. Finally, in order to avoid surgical intervention, an ultrasound-guided axillary brachial plexus block with mepivacaine was performed, resulting in easy removal of the catheter. Axillary brachial plexus nerve blocks are an effective, efficient, and safe intervention with a wide range of indications. This case report demonstrates that an axillary nerve block can be used to treat the entrapment of a transradial artery catheter due to vasospasm.

Successful Management of Severe Peripheral Tissue Ischemia after Arterial Catheterization in Micro Preemies using Humidification & Topical Nitroglycerin

Successful Management of Severe Peripheral Tissue Ischemia after Arterial Catheterization in Micro Preemies using Humidification & Topical Nitroglycerin

Reduced perfusion in systemic sclerosis digital ulcers (both fingertip and extensor) can be increased by topical application of glyceryl trinitrate

ObjectivesIn patients with systemic sclerosis (SSc), fingertip digital ulcers (DUs) are believed to be ischaemic, and extensor surface DUs a result of mechanical factors/microtrauma. Our aim was to assess blood flow response to topical glyceryl trinitrate (GTN) compared to placebo in SSc DUs, looking for differences in pathophysiology between fingertip and extensor lesions. MethodThis was a double-blind, randomised, crossover, placebo-controlled study. Sixteen (6 fingertip, 10 extensor) DUs were each studied twice (one day apart): once with GTN and once with placebo ointment. Perfusion at the DU centre (‘DUCore’) and periphery (‘DUPeriphery’), as measured by laser Doppler imaging was performed before and immediately after ointment application, then every 10min, up to 90min post-application. We calculated the area under the response curve (AUC) and the ratio of peak perfusion to baseline, then compared these between GTN and placebo. ResultsPerfusion was lower in the DUCore compared to the DUPeriphery (ratio of 0.52). The microvessels of the DUCore were responsive to GTN, with an increase in perfusion, with a similar effect in both fingertip and extensor DUs. The AUC and peak/baseline perfusion difference in means (ratio, 95% confidence interval) between GTN and placebo at the DUCore were 1.2 (1.0–1.6) and 1.2 (1.0–1.5) respectively, and at the DUPeriphery were 1.1 (0.8–1.6) and 1.0 (0.9–1.2) respectively. ConclusionDUs (both fingertip and extensor) were responsive to topical GTN, with an increase in perfusion to the ischaemic DU centre. If both fingertip and extensor DUs have a (potentially reversible) ischaemic aetiology, this has important treatment implications.

Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm.

Chondrodermatitis nodularis helicis (CNH) is an idiopathic benign inflammatory painful condition of the ear. Still, to date, no study has yet evaluated nor compared treatments regarding their safety and efficacy. The objective of this study is to review all available treatment modalities of CNH that were described in the literature, compare their efficacy and propose a treatment algorithm. A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. Articles studying the management of CNH that reported data on the cure rates were included in this review. A total of 29 studies were included in the review. The 3 most commonly reported treatments for CNH are surgery, pressure relief, and topical nitroglycerin. Surgery has higher cure rate (82%) compared with pressure relief treatment (37%) or nitroglycerin (51%) (p < .0001). Surgery should be considered as the first-line treatment for CNH. Second-line treatments include nonsurgical therapies, particularly nitroglycerin and pressure relief techniques, alone or in combination. Third-line treatments include newer or less studied methods. Among the treatment modalities, surgery showed the highest cure rates. Adequately designed randomized controlled trials are warranted to compare newer therapeutic methods.

Management of Tissue Ischemia in Mastectomy Skin Flaps: Algorithm Integrating SPY Angiography and Topical Nitroglycerin.

Tissue ischemia can be managed in several different ways based on the cause of the perfusion defect, including topical nitroglycerin or surgical intervention. However, there are times when tissue perfusion is questioned and clinical examination is unable to determine definitively the cause of ischemic tissue and whether it will survive. In this technique article, we describe our comprehensive algorithm for the management of tissue ischemia in mastectomy skin flaps, which can be applied to other plastic surgery procedures by integrating SPY angiography and topical nitroglycerin.

Comparative study of lateral Internal Sphincterotomy verses Topical Glyceryl Trinitrate for treatment of fissure-in-Ano

This prospective randomized interventional study was carried in one of surgical unit of Lahore General Hospital Lahore from 1st January 2002 to 30, December 2002 a total number of 100 patients with both acute and chronic anal fissure were taken and randomly divided in two groups. Group A was treated with 0.2% GTN for 6 weeks and Group B was treated with lateral internal closed Sphincterotomy a follow up after 0, 2nd, 61h weeks and even after 6 months carried out. Peak incidence of disease was observed between 30 and 40 years of age with 56 males and 44 females. 24% patients were with acute fissure and 76% with chronic fissure. In this study with 0.2% GTN overall healing rate of 66.66% for acute fissure and 63.15% for chronic anal fissure was observed. GTN was found less effective in healing the fissure but some what good for initial symptomatic improvement in its comparison 100% healing was observed with lateral internal sphincterotomy with only 10% transient incontinence for flatus. So it was concluded that lateral internal sphincterotomy is superior to GTN and is the procedure of choice for fissure in ano.

Effect of botulinum toxin a and nitroglycerin on random skin flap survival in rats

Background A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive. Objective To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. Methods The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline. Results BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P&lt;0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45). Conclusions BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.

Use of topical nitroglycerin in newborns with ischaemic injuries after vascular cannulation

Use of topical nitroglycerin in newborns with ischaemic injuries after vascular cannulation

Rethinking the Role of Nitroglycerin Ointment in Ischemic Vascular Filler Complications

Soft tissue dermal fillers, both temporary and permanent, are used frequently in facial rejuvenation. As the use of fillers increases, ischemic complications including skin necrosis are becoming more prevalent. In the literature, topical nitroglycerin paste has been recommended in the early treatment of patients presenting with ischemia. The purpose of this study was to evaluate the vascular perfusion effects of topical nitroglycerin paste in an animal model using indocyanine green (ICG) imaging. After Animal Research Committee approval, a rabbit ear model was used to create filler-associated skin ischemia. Ischemia was confirmed to occur after intra-arterial occlusion. Four commonly used soft tissue fillers were injected intra-arterially: Radiesse (Merz USA, Greensboro NC), Restylane (Galderma, Ft. Worth, TX), Juvederm Ultra (Allergan, Irvine CA), Belotero (Merz USA, Greensboro NC) (0.1 ml). A total of 15 ears were used, 1 control and 4 experimental per product. Thirty minutes after occlusion, nitroglycerin ointment USP, 2%(Nitro-Bid) was applied topically to the experimental ears. Vascular perfusion was evaluated with the SPY System (Novadaq Inc.) using ICG imaging. Perfusion images were obtained at baseline, immediately after, and 30 minutes after intra-arterial filler injection, and at 30, 60, 90, and 120 minutes after application of topical nitroglycerin ointment. In this rabbit ear model, no statistically significant improvement in perfusion was noted after topical application of nitroglycerin paste with ICG imaging. In addition, the skin of the rabbit ear post-nitroglycerin ointment appeared to have more of a congested appearance than the controls. Ischemic filler complications are becoming increasingly prevalent. Practitioners often treat these complications with topical nitroglycerin paste based on the knowledge that topical nitroglycerin causes vasodilation. In filler-induced tissue ischemia, however, filler product is present within arterioles. Theoretically, applying nitroglycerin paste, at least early, may not improve perfusion and could worsen ischemia with dilation of vessels and further propagation of product into the smaller arterioles and capillaries. In addition, nitroglycerin paste has systemic effects, including hypotension and dizziness, which may not be tolerated by some patients. Therefore, the authors caution the use of topical nitroglycerin paste in patients presenting with filler-associated ischemia. Further studies in the best treatment algorithms for patients presenting with ischemic complications need to be performed.

Effect of botulinum toxin A and nitroglycerin on random skin flap survival in rats.

A suitable pharmacological substitute for the well-established surgical delay technique for random skin flaps to increase viability has been elusive. To evaluate the effects of nitroglycerin and botulinum toxin type A on random flap survival in a rat model. The present controlled experimental study was performed in the four groups of rats. One week after intervention in each group, the flap was raised and kept in situ, and flap necrosis was evaluated through follow-up. Group 1 received intradermal botulinum toxin type A (BTX-A) and topical nitroglycerin 2%; group 2 received BTX-A and topical Vaseline (Unilever, USA); group 3 received topical nitroglycerin and intradermal normal saline; and group 4 received topical Vaseline and intradermal normal saline. BTX-A reduced the area of necrosis compared with control (24% versus 56% respectively; P<0.001). Nitroglycerin application was associated with a trend toward improved flap viability (42% versus 56%; P=0.059). The combination of topical nitroglycerin and BTX-A, compared with Vaseline and BTX-A, was associated with decreased flap necrosis (16.1% versus 24%, respectively), although it was not statistically significant (P=0.45). BTX-A was effective in reducing distal flap necrosis. The effect of BTX-A was significantly more pronounced than nitroglycerin ointment.

Topical Nitroglycerin for Osteoporosis: Old Drug New Application

ABSTRACT Osteoporosis is a progressive bone disease characterized by a decrease in the bone mass and density, which can lead to an increased risk of fracture. Multiple treatments have been formulated for it like calcium, vitamin D supplements, bisphosphonates, raloxifene, hormone replacement therapies, teriparatide and calcitonin. However, all of these have their own shortcomings. Topical nitroglycerin is a cost-effective, novel medication that not only increases bone formation but also decreases its resorption, and also has the potential to decrease vertebral fractures more than that provided by the existing treatments. Therefore, it could be the answer to the need of an efficacious, cost-effective, affordable, safe and a convenient form of therapy for the prevention of post-menopausal bone loss and osteoporosis as a whole. Therefore, we recommend that individuals with osteoporosis be treated with topical nitroglycerin ointment (15 mg/day). How to cite this article Malhotra J, Garg R, Agrawal P, Agarwal A, Singh O. Topical Nitroglycerin for Osteoporosis: Old Drug New Application. J South Asian Feder Obst Gynae 2016;8(1):1-3.

The Effect of Topical Glycerol Trinitrate on Laser-Aided Facial Hair Removal: A Triple-Blinded Randomized Clinical Trial.

Our purpose in this study was to assess the effect of topical glyceryl trinitrate on the efficacy of long-term white hair removal aided by laser therapy in hirsute women. Nitric oxide (NO) induces vasorelaxation and augmented perfusion when released from endothelial cells or from an alternatively provided exogenous source. Separately, vascular endothelial growth factor (VEGF)-mediated angiogenesis during the anagen phase, the phase most susceptible to laser elimination, and modulation of VEGF by NO, has been discussed previously, but there are limited data regarding an efficient method for long-term white hair removal. We conducted a triple-blinded randomized controlled clinical trial. Hirsute women with excess facial hair without a known allergy to nitroglycerin derivatives were recruited, and randomly allocated to receive either premedication with 2 g glycerol trinitrate 3 days before the laser sessions once a day, or placebo. All the participants underwent six laser sessions with 1-month intervals. Baseline hair numbers were counted before, 3, 6, and 12 months after the first session. Data were analyzed with repeated measures ANOVA test. A total of 83 patients were enrolled in control (43) and case (40) groups. The trends for hair reduction in both studied groups were significant (p < 0.001), but there were no significant differences between the case and control groups during the study period. According to our findings, all patients, regardless of whether or not they used trinitrate, had significant success with hair removal. This study could not differentiate hair removal efficacy between the study groups. Studies with other laser types and larger sample sizes are suggested to investigate the effect of NO on hair production.

Effect of Glyceryl Trinitrate Ointment on Pain Control After Hemorrhoidectomy: A Meta-analysis of Randomized Controlled Trials.

Hemorrhoidectomy is associated with postoperative pain and prolonged wound healing. Glyceryl trinitrate has been shown to decrease muscle spasm and increase anodermal blood flow. A meta-analysis of randomized controlled trials was conducted to evaluate the efficacy of topical glyceryl trinitrate application in pain relief after hemorrhoidectomy. PubMed, EMBASE, Cochrane Library, Scopus, and ClinicalTrials.gov registries were searched for studies published before August 2015. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate a pooled effect size using random effects models. Pain was assessed using a visual analog scale on days 1, 3, 7, and 14 after operation. Secondary outcomes included time taken to resume routine activities, wound healing at 3 weeks after operation, complication, and headache incidence. A total of 12 trials with 1095 patients were reviewed. Significant pain reduction was observed on days 1, 3, 7, and 14 after hemorrhoidectomy in the glyceryl trinitrate groups. Glyceryl trinitrate-treated patients appeared to resume routine activities earlier than those in the control group (weight mean difference -7.52; 95% confidence interval: 16.13-1.08). The wound healing rates 3 weeks after operation were significant higher in the glyceryl trinitrate-treated groups than in the control group (risk ratio 1.79; 95% confidence interval: 1.38-2.33). However, the incidence of headache significantly increased in the glyceryl trinitrate group (risk ratio 3.68; 95% confidence interval: 1.62-8.34). Topical application of glyceryl trinitrate effectively relieves pain and promotes wound healing after hemorrhoidectomy; however, the substantial headache incidence may limit extensive application.

A phase III randomized trial of adding topical nitroglycerin to first-line chemotherapy for advanced nonsmall-cell lung cancer: the Australasian lung cancer trials group NITRO trial

BackgroundWe sought to determine whether the substantial benefits of topical nitroglycerin with first-line, platinum-based, doublet chemotherapy in advanced nonsmall-cell lung cancer (NSCLC) seen in a phase II trial could be corroborated in a rigorous, multicenter, phase III trial. Patients and methodsPatients starting one of five, prespecified, platinum-based doublets as first-line chemotherapy for advanced NSCLC were randomly allocated treatment with or without nitroglycerin 25mg patches for 2 days before, the day of, and 2 days after, each chemotherapy infusion. Progression-free survival (PFS) was the primary end point. ResultsAccrual was stopped after the first interim analysis of 270 events. Chemotherapy was predominantly with carboplatin and gemcitabine (79%) or carboplatin and paclitaxel (18%). The final analysis included 345 events in 372 participants with a median follow-up of 33 months. Topical nitroglycerin had no demonstrable effect on PFS [median 5.0 versus 4.8 months, hazard ratio (HR) = 1.07, 95% confidence interval (CI) 0.86–1.32, P = 0.55], overall survival (median 11.0 versus 10.3 months, HR = 0.99, 95% CI 0.79–1.24, P = 0.94), or objective tumor response (31% versus 30%, relative risk = 1.03, 95% CI 0.82–1.29, P = 0.81). Headache, hypotension, syncope, diarrhea, dizziness, and anorexia were more frequent in those allocated nitroglycerin. ConclusionThe addition of topical nitroglycerin to carboplatin-based, doublet chemotherapy in NSCLC had no demonstrable benefit and should not be used or pursued further. Clinical Trials NumberAustralian New Zealand Clinical Trials Registry Number ACTRN12608000588392.

The Usefulness of 0.2% Topical Nitroglycerin for Chondrodermatitis Nodularis Helicis

Background and objectiveChondrodermatitis nodularis helicis (CNH) is a painful idiopathic degenerative condition involving the skin and cartilage of the helix or antihelix of the ear. Topical nitroglycerin 2% is a relatively recent treatment option for CNH that has produced good results, although with adverse effects (17% of cases). The use of a lower concentration would probably achieve similar results with fewer adverse effects. The aim of this study was to evaluate the effectiveness and safety of topical nitroglycerin 0.2% in the treatment of CNH. Material and methodsWe performed a retrospective observational study of patients treated in 2 Spanish hospitals between 2012 and 2014. The effectiveness of treatment was determined by clinical photography and assessment of symptoms using a verbal numerical rating scale. ResultsOf the 29 patients treated, 93% showed clinical improvement. In the group of responders, mean treatment duration was 1.8 months and mean follow-up was 5.9 months. Overall tolerance was good in all cases. ConclusionTopical nitroglycerin 0.2% is an effective and well-tolerated conservative treatment option that improves the appearance of lesions and provides symptomatic relief in the majority of patients with CNH.

La utilidad de la nitroglicerina tópica al 0,2% en la condrodermatitis nodular del hélix

Background and objectiveChondrodermatitis nodularis helicis (CNH) is a painful idiopathic degenerative condition involving the skin and cartilage of the helix or antihelix of the ear. Topical nitroglycerin 2% is a relatively recent treatment option for CNH that has produced good results, although with adverse effects (17% of cases). The use of a lower concentration would probably achieve similar results with fewer adverse effects. The aim of this study was to evaluate the effectiveness and safety of topical nitroglycerin 0.2% in the treatment of CNH. Material and methodsWe performed a retrospective observational study of patients treated in 2 Spanish hospitals between 2012 and 2014. The effectiveness of treatment was determined by clinical photography and assessment of symptoms using a verbal numerical rating scale. ResultsOf the 29 patients treated, 93% showed clinical improvement. In the group of responders, mean treatment duration was 1.8 months and mean follow-up was 5.9 months. Overall tolerance was good in all cases. ConclusionTopical nitroglycerin 0.2% is an effective and well-tolerated conservative treatment option that improves the appearance of lesions and provides symptomatic relief in the majority of patients with CNH.

Phase I dose escalation trial of nitroglycerin in addition to 5-fluorouracil and radiation therapy for neoadjuvant treatment of operable rectal cancer

Nitric oxide donors decreased cell survival in vitro and tumor load in vivo in models of rectal cancer subjected to ionizing radiation. Nitroglycerin (NTG) transdermal patches, added to chemotherapy, have been shown to improve outcomes in lung cancer patients. This open-label, nonrandomized, multicohort, dose escalation, phase I trial had a primary endpoint to evaluate the safety, tolerability, feasibility, dose-limiting toxicity and maximum tolerated dose of topical NTG in addition to 5-fluorouracil and radiation therapy for neoadjuvant treatment of locoregionally advanced operable rectal cancer. The secondary endpoint was rate of pathologic complete response (pCR). Patients were assigned to 3 sequential cohorts of escalating dose levels of commercially available NTG patches (0.2, 0.4, and 0.6 mg/h), each cohort was intended to consist of 3 patients. Thirteen patients were enrolled in the trial as specified in the dose escalation protocol. They were all male with a median age of 59.4 ± 2.5 (SEM) years. The observed toxicities were mild to moderate and manageable. Four patients developed asymptomatic grade 3 lymphopenia during the chemoradiation that resolved promptly upon completion. One patient had a non-ST segment elevation MI and 1 patient developed diarrhea. None of these toxicities were attributed to NTG except for 1 patient who developed a grade 3 headache. This required an additional group of patients at the same dose and no other patient experienced headaches. pCR was 17%. NTG patches are well-tolerated and it is feasible to proceed with a phase II trial at the maximum dose examined (0.6 mg/h).

PD2-12 TREATMENT OF PRIAPISM IN THE EMERGENCY DEPARTMENT PRIOR TO UROLOGIC SURGERY CONSULTATION: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Penis/Testis/Urethra: Benign Disease1 Apr 2015PD2-12 TREATMENT OF PRIAPISM IN THE EMERGENCY DEPARTMENT PRIOR TO UROLOGIC SURGERY CONSULTATION: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION Elizabeth Green, Stephen Kappa, Shreyas Joshi, Melissa Kaufman, and Doug Milam Elizabeth GreenElizabeth Green More articles by this author , Stephen KappaStephen Kappa More articles by this author , Shreyas JoshiShreyas Joshi More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , and Doug MilamDoug Milam More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.195AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To review the medical management of priapism patients by the Emergency Department (ED) prior to Urologic Surgery consultation in a contemporary cohort of patients. METHODS Retrospective review of consecutive priapism cases at a single institution from March 2004 to June 2014 was performed utilizing an inpatient Urologic Surgery consultation database. Treatments administered in the ED were gathered from a review of treatment orders. Patients were determined to have been treated successfully prior to Urologic Surgery consultation if they experienced detumescence without Urologic intervention. RESULTS Of the 102 cases of priapism treated at our center, 52 patients (50.9%) were treated with oral or IV medications ordered in the ED. Thirty-nine cases (38.2%) were treated with terbutaline, of which 26 received the medication subcutaneously (median dose 0.25mg) and 14 received the medication administered orally (median dose 10mg). Twenty-one patients (20.5%) were treated with oral pseudoephedrine (median dose 60mg), 9 (8.8%) received diphenhydramine, 6 (5.9%) were treated with topical nitroglycerin paste applied to the penis, and 3 (2.9%) patients were treated with IV sodium bicarbonate. Of the 52 cases treated with medication in the ED, 8 cases (7.8% of all cases, 15.8% of cases treated medically in the ED) experienced detumescence without further intervention. All 8 of these patients received terbutaline (5 patients received median dose 0.5mg subcutaneously, 4 patients received median 10mg po, 1 patient received both). Five of these patients received a median dose of 90mg pseudoephedrine, 3 received topical nitroglycerin paste, and 1 received IV sodium bicarbonate. Of the 8 successfully treated cases, 5 resulted from sickle cell disease, 1 from a psychotropic medication, 1 from cocaine, and 1 case was defined as idiopathic. CONCLUSIONS In this contemporary case series of patients treated for priapism, half of all patients received medications in the ED intended to treat their priapism, of which 15.8% experienced detumescence without further intervention. All patients treated successfully with medications alone received terbutaline, with additional medications including pseudoephedrine, topical nitroglycerin paste, and sodium bicarbonate. To our surprise, almost 20% of patients were initially treated in our own ED with medications judged ineffective by the AUA guidelines. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e44 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Green More articles by this author Stephen Kappa More articles by this author Shreyas Joshi More articles by this author Melissa Kaufman More articles by this author Doug Milam More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...