Treatment Of Priapism Research Articles

Treatments for priapism in boys and men with sickle cell disease.

Sickle cell disease comprises a group of genetic haemoglobin disorders. The predominant symptom associated with sickle cell disease is pain resulting from the occlusion of small blood vessels by abnormally 'sickle-shaped' red blood cells. There are other complications, including chronic organ damage and prolonged painful erection of the penis, known as priapism. Severity of sickle cell disease is variable, and treatment is usually symptomatic. Priapism affects up to half of all men with sickle cell disease, however, there is no consistency in treatment. We therefore need to know the best way of treating this complication in order to offer an effective interventional approach to all affected individuals. This is an update of a previously published review. To assess the benefits and risks of different treatments for stuttering (repeated short episodes) and fulminant (lasting for six hours or more) priapism in sickle cell disease. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also searched trial registries. Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 09 September 2019. Date of most recent search of trial registries and of Embase: 01 October 2019. All randomised or quasi-randomised controlled trials comparing non-surgical or surgical treatment with placebo or no treatment, or with another intervention for stuttering or fulminant priapism. The authors independently extracted data and assessed the risk of bias of the trials. Three trials with 102 participants were identified and met the criteria for inclusion in this review. These trials compared stilboestrol to placebo, sildenafil to placebo and a four-arm trial which compared ephedrine or etilefrine to placebo and ranged in duration from two weeks to six months. All of the trials were conducted in an outpatient setting in Jamaica, Nigeria and the UK. None of the trials measured our first primary outcome, detumescence. However, all three trials reported on the reduction in frequency of stuttering priapism, our second primary outcome; and from the evidence included in this review, we are uncertain whether stilboestrol, etilefrine or ephedrine reduce the frequency of stuttering priapism as the certainty of the evidence has been assessed as very low. Additionally, we conclude that sildenafil may make little or no difference (low-certainty evidence). Two trials reported on immediate side effects and we are uncertain whether etilefrine or ephedrine reduce the occurrence of these (very low-certainty of evidence) and also conclude that sildenafil may make little or no difference in side effects (low-quality evidence). Given that all of the trials were at risk of bias and all had low participant numbers, we considered the certainty of the evidence to be low to very low. There is a lack of evidence for the benefits or risks of the different treatments for both stuttering and fulminant priapism in sickle cell disease. This systematic review has clearly identified the need for well-designed, adequately-powered, multicentre randomised controlled trials assessing the effectiveness of specific interventions for priapism in sickle cell disease.

A Systematic Literature Review of the Burden of Ischemic Priapism in Patients with Sickle Cell Disease

INTRODUCTION: Ischemic or low-flow priapism is a serious condition characterized by a persistent, painful erection that lasts at least 4 hours or is unrelated to sexual stimulation. Both stuttering (repeated short episodes) and fulminant (long-lasting) priapism are prevalent in men and boys with sickle cell disease (SCD). Approximately 40% of patients with SCD will experience priapism during their lifetime. The objective of this study was to conduct a systematic literature review (SLR) to identify published studies reporting the burden associated with priapism in patients with SCD. METHODS: MEDLINE, Embase, Cochrane CENTRAL/CDSR and 14 congresses were searched from May 9-16, 2019. Results were screened against predefined criteria by two independent researchers. Studies assessing the clinical, humanistic, or economic burden of human patients with SCD and priapism (N≥15) were included. Outcomes of interest included priapism-related symptoms, treatment-related complications, quality of life (QoL), and economic burden. RESULTS: The literature search identified 1236 articles; 62 full-text studies were reviewed in detail and 34 studies were included in the analysis. Most studies were retrospective observational (21), others were prospective (7 observational, 6 interventional). Study size varied widely (range: 15-10,788 patients). Of 27 studies that reported mean or median patient age, the age statistic for patients with SCD and priapism ranged from 10 to 32. Overall, 19 studies reported at least one aspect of clinical burden. Thirteen reported the rate of erectile dysfunction or impotence, ranging from 0% to 56%. Eight reported treatment-related complications, including perceived penile scarring/deformity (19.4%) and small intrapenile hematoma (13.3%). Nineteen studies reported QoL outcomes. Eight reported physical outcomes, including a negative impact of SCD-related priapism on sleep quality and worse scores on periodic limb movement and apnea hypopnea indices. Seven reported measures of sexual function, including low rates of satisfactory sexual intercourse. One study reported a diminished Sexual Health Inventory for Men score in patients with active priapism, and another found a statistically significant relationship between stuttering priapism and premature ejaculation. Three studies reported measures of mental function, one of which outlined increased cognitive fatigue and impaired emotional functioning among children with priapism and another reported that 36% of patients had substantial to very extreme worry regarding episodes of priapism. Use of validated measures for QoL were limited: 3 studies assessed patients with the International Index of Erectile Function (IIEF) and 1 with the Priapism Impact Profile (PIP). No studies measuring the burden to caregivers of pediatric patients with priapism were identified. Eight studies reported the economic burden of priapism in patients with SCD, including rates of emergency department visits (4 studies: 56.5% sought hospital treatment - 26/46; 49.8% admission to the hospital out of emergency department visits - 5371/10,788; 50.4% admitted at the emergency department - 930/1844; 26% vs. 11% readmission vs no readmission - p <0.001) and hospital length of stay (4 studies: mean 3.38 days; mean 3.8 days; median 2 days; median 5 days in patients who received an exchange transfusion as a treatment for priapism.). Three studies reported direct treatment costs, ranging from a mean of $4496 (2015 USD) for patients who did not undergo penile operations to a mean of $19,670 (2013 USD) total adjusted hospital costs for patients receiving both transfusions and urologic procedures. CONCLUSIONS: This SLR identified 34 studies reporting the burden of priapism in patients with SCD. No RCTs were identified. The use of comprehensive or validated measures of humanistic burden was limited. Manifestations of priapism are wide-ranging, including painful treatment-related complications, impaired sleep, and diminished physical, mental and sexual function. Patients with priapism and SCD are more likely to visit the emergency department and experience longer hospital stays compared to SCD patients without priapism. Together, the evidence identified in this SLR indicates that priapism not only can result in erectile dysfunction, but can impair multiple dimensions of a patient's physical and mental health. Disclosures Nellesen: Analysis Group, Inc.: Consultancy. Lucas:Analysis Group, Inc.: Consultancy. Liu:Analysis Group, Inc.: Consultancy. Bhor:Novartis: Employment, Equity Ownership. Paulose:Novartis Pharmaceuticals Corporation: Employment.

CML patients presenting with priapism: Is there any disparity in outcome?

e18545 Background: Priapism, a urological emergency that needs prompt treatment, is an uncommon presenting feature of chronic myeloid leukemia (CML). CML frequently occurs in younger males and adolescents in developing countries. Occurrence of erectile dysfunction (ED) in this particular age group can severely decrease the quality of life. It is known that immediate treatment of priapism preserves erectile function. The data on the outcome of priapism in CML patients from developing world is limited. Methods: We analysed the CML patients treated at PGIMER Chandigarh from January 2003 to December 2018. Baseline spleen and liver size, hematological parameters, Sokal and Hasford score were documented. Duration of priapism, treatment received by the patients, and response to Imatinib were recorded. The severity of ED was assessed by SHIM (Sexual Health Inventory for Men) score. Results: Twenty-three patients (1.7%) out of total 1350 male CML-CP patients had priapism at diagnosis. The median age was 24 years (range 13 – 50 years); 60.8% patients belonged to 21 – 40 years age group. Median duration of priapism was 8 days (range 2 – 25 days). Splenomegaly and hepatomegaly were found in 91.3% and 56.5% patients, respectively. Baseline median hemoglobin was 9.9 g/dL; TLC was 283000/mm3 and platelet count was 352000/mm3. Based on Sokal score, 4/23, 16/23 and 3/23 patients belonged to low, intermediate and high risk categories, respectively. According to Hasford score, 7/23, 14/23 and 2/23 patients belonged to low, intermediate and high risk categories, respectively. All patients received cytoreductive therapy [hydroxyurea and Imatinib]; 21 patients underwent penile aspiration, 13 patients underwent therapeutic leucapheresis and 8 patients underwent distal penile shunt surgery. Majority of the patients (78.2%) achieved CHR at 6 weeks and 21 patients achieved MMR at 12 months. ED could be assessed in 14 patients on follow up. As per SHIM score, 2/14 and 12/14 patients had moderate and severe ED, respectively. The occurrence and severity of ED was unaffected by leucapheresis or shunt surgery. Conclusions: We found severe ED on follow up among majority of CML-CP patients with priapism at presentation. Despite favourable response to Imatinib, long duration of symptoms and hyperleucocytosis probably contributed to ischemic priapism and severe ED in the study cohort. We conclude that prolonged and untreated priapism in CML-CP patients is a major risk factor for ED. There is a need to sensitise the primary care physicians and surgeons in the developing world regarding this grave complication in CML patients.

The effects of oxytocin on penile tissues in experimental priapism model in rats.

This study aimed to demonstrate the effects of oxytocin on penile tissues in ischemia-reperfusion injury developed after priapism. Forty Wistar Albino strain male rats were divided into four groups. The control group (n = 10) was not intervened. In Group 2, a rat model of priapism was constructed and maintained for 1 h. In Group 3, reperfusion was ensured for 30min following priapism. Rats in Group 4 rats were given oxytocin 30min before the induction of reperfusion following priapism. All rats were penectomized, and adequate amounts of blood sample were drawn. Inflammation, vasocongestion, desquamation, and edema in penile tissue were scored between 0 and 3 points (0: normal, 1: mild, 2: moderate, 3: severe) to evaluate the severity of tissue damage. The activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and the levels of malondialdehyde (MDA), and nitric oxide (NO) in blood samples were determined spectrophotometrically. In histopathological examination, statistically significant positive changes were detected in vasocongestion, inflammation, desquamation, and edema scores in Group 4 than in Group 2 and Group 3 (p < 0.001). Biochemical test results revealed that NO levels were significantly lower in Group 4 than in Group 3 (p < 0.001). Serum GSH-Px activities in Group 4 significantly increased when compared with the other groups 2 and 3 (p = 0.002, p = 0.001, respectively). There was no statistical difference among the groups regarding SOD activities and MDA levels (p > 0.05). Oxytocin protected against priapism-induced ischemia-reperfusion injury developed in cavernosal tissue as observed based on histopathological and biochemical evidence. Although this is an experimental study, oxytocin can be thought as an alternative drug in the treatment of priapism.

Le priapisme : diagnostic et prise en charge

Our aim was to present a synthesis on the diagnosis and treatment of priapism. For this purpose, a literature search was performed through PubMed to analyze literature reviews and guidelines regarding priapism. Priapism is an erection that persists more than 4hours. There are 3 types of priapism: ischemic priapism, non-ischemic priapism and recurrent (stuttering) priapism. Ischemic priapism, often idiopathic, is the most frequent. When diagnosed, an urgent management is required to limit erectile dysfunction. Sickle-cell patients are prone to have ischemic and stuttering priapism. Non-ischemic priapism usually occurs after perineal trauma. Priapism management depends on the type of priapism. Medical treatment (corporal aspiration and injection of sympathomimetics) then if failed, surgery are indicated for ischemic priapism. The persistence of a non-ischemic priapism most likely requires a radiologic embolization. Priapism is a condition that often requires emergency treatment to spare erectile function. It appears crucial to know this condition and its management.

Quetiapine-induced priapism

Priapism is a urologic emergency characterized by a prolonged, persistent, and painful penile erection in the absence of sexual stimulation. The reports indicate that several conditions can cause priapism such as psychotropic medication. One of the mechanisms by which antipsychotics are believed to induce priapism is through alpha 1-antagonism. This case is of a 28-year-old male with a history of bipolar disorder with priapism related to quetiapine. In this case, the treatment of priapism includes discontinuation of the offending agent and drainage of the corpus cavernosum twice a day along with intracavernosal phenylephrine injections. Previous episodes of medication-induced priapism may increase the risk of priapism in patients afterwards. It is important to inform patients about the priapism that may occurs as a side effect of medications.

Role of Penile Prosthesis in Priapism: A Review.

Ischemic priapism is a urological emergency that has been associated with long-standing and irreversible adverse effects on erectile function. Studies have demonstrated a linear relationship between the duration of critically ischemic episodes and the subsequent development of corporal fibrosis and irreversible erectile function loss. Placement of a penile prosthesis is a well-established therapeutic option for the management of erectile dysfunction secondary to ischemic priapism, and will be the focus of this review. Review of the current literature demonstrates a growing utilization of penile prostheses in the treatment of erectile dysfunction secondary to ischemic priapism. Unfortunately, there is a paucity of randomized-controlled trials describing the use of prosthesis in ischemic priapism. As a result, there is a lack of consensus regarding the type of prosthesis (malleable vs. inflatable), timing of surgery (acute vs. delayed), and anticipated complications for each approach. Both types of prostheses yielded comparable complication rates, but the inflatable penile prosthesis have higher satisfaction rates. Acute treatment of priapism was associated with increased risk of prosthetic infection, and could potentially cause psychological trauma, whereas delayed implantation was associated with greater corporal fibrosis, loss of penile length, and increased technical difficulty of implantation. The paucity of high-level evidence fuels the ongoing discussion of optimal use and timing of penile prosthesis implantation. Current guidance is based on consensus expert opinion derived from small, retrospective studies. Until more robust data is available, a patient-centered approach and joint decision-making between the patient and his urologist is recommended.

Treatments for priapism in boys and men with sickle cell disease.

Sickle cell disease comprises a group of genetic haemoglobin disorders. The predominant symptom associated with sickle cell disease is pain resulting from the occlusion of small blood vessels by abnormally 'sickle-shaped' red blood cells. There are other complications, including chronic organ damage and prolonged painful erection of the penis, known as priapism. Severity of sickle cell disease is variable, and treatment is usually symptomatic. Priapism affects up to half of all men with sickle cell disease, however, there is no consistency in treatment. We therefore need to know the best way of treating this complication in order to offer an effective interventional approach to all affected individuals. To assess the benefits and risks of different treatments for stuttering (repeated short episodes) and fulminant (lasting for six hours or more) priapism in sickle cell disease. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also searched trial registries.Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 15 September 2017.Date of most recent search of trial registries and of Embase: 12 December 2016. All randomised or quasi-randomised controlled trials comparing non-surgical or surgical treatment with placebo or no treatment, or with another intervention for stuttering or fulminant priapism. The authors independently extracted data and assessed the risk of bias of the trials. Three trials with 102 participants were identified and met the criteria for inclusion in this review. These trials compared stilboestrol to placebo, sildenafil to placebo and ephedrine or etilefrine to placebo and ranged in duration from two weeks to six months. All of the trials were conducted in an outpatient setting in Jamaica, Nigeria and the UK. None of the trials measured our first primary outcome, detumescence but all three trials reported on the reduction in frequency of stuttering priapism, our second primary outcome. No significant effect of any of the treatments was seen compared to placebo. Immediate side effects were not found to be significantly different from placebo in the two trials where this information was reported. We considered the quality of evidence to be low to very low as all of the trials were at risk of bias and all had low participant numbers. There is a lack of evidence for the benefits or risks of the different treatments for both stuttering and fulminant priapism in sickle cell disease. This systematic review has clearly identified the need for well-designed, adequately-powered, multicentre randomised controlled trials assessing the effectiveness of specific interventions for priapism in sickle cell disease.

Management of refractory ischemic priapism: current perspectives.

ObjectivesThe aim of the present manuscript is to review the current literature on priapism, focusing on the state-of-the-art knowledge of both the diagnosis and the treatment of the refractory ischemic priapism (IP).MethodsPubmed and EMBASE search engines were used to search for words “priapism”, “refractory priapism”, “penile prosthesis”, “diagnosis priapism”, “priapism treatment”, “penile fibrosis”, “priapism therapy”. All the studies were carefully examined by the authors and then included in the review.ResultsFirst-line treatment involves ejaculation, physical exercise and cold shower followed by corporal blood aspiration and injection of α-adrenoceptor agonists. Subsequently, a distal or proximal shunt may be considered. If none of the treatment is effective or the priapism episode lasts >48 hours penile prosthesis implantation could be the only option to solve the priapism and treat the ongoing erectile dysfunction.ConclusionThe management of IP is to achieve detumescence of persistent penile erection and to preserve erectile function after resolution of the priapic episode. On the other hand, penile fibrosis and following shortening should be prevented. Early penile prosthesis implantation in patients with refractory IP is able to solve both the priapic episode and prevent the otherwise certain penile shortening. Penile prosthesis implantation is the actual gold standard of care in cases of refractory IP.

Unusual Case of Priapism in Emergency Department of Tertiary Care Hospital of Eastern Nepal

Priapism is a rare and unusual presentation in Emergency Department of Nepal and is really a challenge for the working Emergency Physicians. In Nepalese context it is a social stigma and is often a pitfall due to possible delayed presentation. A young Nepalese Hindu male presented to our Emergency Department with post coital priapism who seeked help only after ninety-six hours in request of his wife. In limited resource hospital settings with delayed presentation, aspiration and irrigation of corpora cavernosa with heparinized saline had shown good outcome in treatment of priapism without any postoperative complications regardless of prolonged stay in emergency department.

Embolization Treatment of High-Flow Priapism.

Priapism is prolonged erection that persists beyond or is unrelated to sexual stimulation. There are two main types of priapism: high flow and low flow. The treatment of priapism will differ depending on the diagnosis of these two different types. In particular, interventional radiology plays a key role in treating patients with high-flow priapism. This article will review the diagnosis and treatment of the high-flow priapism.

Beneficial Effect of the Nitric Oxide Donor Compound 3-(1,3-Dioxoisoindolin-2-yl)Benzyl Nitrate on Dysregulated Phosphodiesterase 5, NADPH Oxidase, and Nitrosative Stress in the Sickle Cell Mouse Penis: Implication for Priapism Treatment.

Patients with sickle cell disease (SCD) display priapism, and dysregulated nitric oxide (NO) pathway may contribute to this condition. However, current therapies offered for the prevention of priapism in SCD are few. The 3-(1,3-dioxoisoindolin-2-yl)benzyl nitrate (compound 4C) was synthesized through molecular hybridization of hydroxyurea and thalidomide, which displays an NO-donor property. This study aimed to evaluate the effects of compound 4C on functional and molecular alterations of erectile function in murine models that display low NO bioavailability, SCD transgenic mice, and endothelial NO synthase and neuronal NO synthase double gene-deficient (dNOS-/) mice, focusing on the dysregulated NO-cGMP- phosphodiesterase type 5 (PDE5) pathway and oxidative stress in erectile tissue. Wild-type, SCD, and dNOS-/- mice were treated with compound 4C (100 μmol/kg/d, 3 weeks). Intracavernosal pressure in anesthetized mice was evaluated. Corpus cavernosum tissue was dissected free and mounted in organ baths. SCD and dNOS-/- mice displayed a priapism phenotype, which was reversed by compound 4C treatment. Increased corpus cavernosum relaxant responses to acetylcholine and electrical-field stimulation were reduced by 4C in SCD mice. Likewise, increased sodium nitroprusside-induced relaxant responses were reduced by 4C in cavernosal tissue from SCD and dNOS-/- mice. Compound 4C reversed PDE5 protein expression and reduced protein expressions of reactive oxygen species markers, NADPH oxidase subunit gp91phox, and 3-nitrotyrosine in penises from SCD and dNOS-/- mice. In conclusion, 3-week therapy with the NO donor 4C reversed the priapism in murine models that display lower NO bioavailability. NO donor compounds may constitute an additional strategy to prevent priapism in SCD.

P-03-067 Treatment of priapism with PDE-5 inhibitors

P-03-067 Treatment of priapism with PDE-5 inhibitors

044 The Effect of Treatment for Priapism on Erectile Dysfunction

044 The Effect of Treatment for Priapism on Erectile Dysfunction

Intracavernosal metaraminol bitartrate for treatment of priapism resulting from circumcision: a case report.

IntroductionPriapism is an uncommon disorder of involuntary prolonged erection beyond sexual excitement or desire. Herein, we present a rare case of priapism resulting from traditional circumcision under regional anesthesia with dorsal penile nerve block by xylocaine, which was successfully treated by intracavernosal injection of metaraminol bitartrate.Case descriptionA 37-year-old man visited our out-patient department for a penile erection, which had been observed during the surgery, lasting for 21 days. 10 days after circumcision, he accepted simple corporeal aspiration in another hospital but it had no effect. In our hospital, he was injected intracavernosally twice a day, with 2 mg metaraminol bitartrate diluted in 1 ml normal saline every time. Complete resolution of penile tumescence was achieved after injection for 7 days, no complications were observed.Discussion and evaluationPriapism developed following circumcision is very uncommon. This particular case was diagnosed as high-flow non-ischemic priapism, and is the first reported event of priapism resulting from circumcision which was finally successfully treated with the efficient and minimally invasive method of intracavernosal injection of metaraminol bitartrate.ConclusionsIntracavernous injection of metaramino bitartrate might be a simple, effective and safe method for relief of priapism associated with circumcision. Yet, more clinical studies are needed to validate the effectiveness of intracavernosal metaramino bitartrate for post-circumcision priapism.

Use of Bosentan, Theophylline and Vardenafil in Treatment of Priapism

Objective: To evaluate the early therapeutic alternatives such as Bosentan an Endothelin receptor blocker, Theophylline and Adenosin receptor blocker and Vardenafil a non-selective Phosphodiesterase 5 enzyme inhibitor for the therapy of ischemic priapism in the rat models. Methods: Twenty-four Sprague-Dawley rats were randomly divided into 4 equal groups. Control group, Vardenafil group, Bosentan group and Theophylline group. Erection was provided by vacuum constriction method and it was maintained for 4 hours for achieving the priapism in all groups. Then, Six rats from each group were sacrificed by cervical dislocation. Consequently, cavernous tissue samples were collected and placed in the tissue bath. Tissue samples were prepared as 0.5-0.2 cm. strips and put into heat jacketed double walled organ bath containing 37°C krebs solution which is constantly bubbled with 95% O2 and 5 % CO2 and mounted at a resting tension of 1000 mg. After taking the 1 hour record of the three groups except the control group, Bosentan, Theophylline and Vardenafil were admitted in increasing doses. Consequently the alterations of the contractions in the strips due to the drugs and their increasing doses are observed. Results: In this study we detected that Bosentan increased the frequency and amplitude of the contractions of the cavernous tissue in the Priapism status in a statistically significant manner, Theophylline decreased the frequency and the amplitude significantly and Vardenafil had statistically no effect on the frequency and amplitude. Conclusion: Inhibition of priapism induced apoptosis with Bosentan, seems promising on preserving erectile function. Key words: Bosentan, ischemic priapism, theophylline, vardenafil

Surgical treatment of priapism in sickle cell patients: A noble therapy in preserving erection

Background: Priapism is a pathological condition of erectile tissue tumescence characterized by prolonged erection without any sexual stimulation and excitement. A classification commonly used to differentiate clinical presentation of priapism divides priapism into ischemic (low-flow) and nonischemic (high-flow) priapism. They have different pathological consequences and also differ in the overall management. The present study reviewed the modes of presentation and management and results of treatment of priapism in sickle cell patients. Patients and Methods: All consecutive sickle cell patients with priapism who were managed by surgical intervention at our unit between January 2000 and December 2011 were included in this study. The demographic characteristics, predisposing factors, and mode of treatment were reviewed. The outcomes of the treatment were analyzed using statistical software Statistical Package for the Social Sciences (SPSS) version 16. Results: Thirty-three patients with priapism due sickle cell disease were seen over 12 years; two patients were lost to follow-up and were excluded. Their age range was 2-35 years with a mean of 22.5 years. The patients who had an El-Ghorab cavernospongiosus shunt (ECS) had better results than those who had a conventional perineal cavernospongiosus shunt (PCS). Eleven patients with recurrent previous episodes of priapism had reduced or absent erection. Erection was better in patients with shorter duration of priapism and not more than one previous episode. The mean duration of symptoms from the time of presentation to treatment was 3 days. Of the twenty-one patients who presented in ≤2 days, 18 had normal erections and 3 had reduced erections at 12 weeks. Of the 12 patients who presented in ≥3 days, 5 had normal erections, 2 had reduced erections, and 5 had no erection. Ten patients had treatment with sildenafil during the follow-up period with some improvement. One patient who had PCS developed perineal urethrocutaneous fistula. Conclusion: Early surgical intervention is recommended in patients with ischemic priapism; regardless of the delay in presentation, and immediate unilateral distal venous shunt should be considered the best way to preserve erection. More prospective randomized studies are required to confirm these assertions.

Outcome and erectile function following treatment of priapism: An institutional experience.

Introduction:Priapism has a devastating consequence on the sexual function of men if not promptly managed. We are presenting our experience of the treatment of priapism and the status of sexual function even following successful detumescence achieved after treatment.Materials and Methods:Nineteen patients, who presented with priapism from January 2012 to December 2014, were included in the study. After obtaining a detailed history; color Doppler ultrasonography of penis and blood gas analysis of the initial corporal aspirate were done to ascertain the type of priapism. Standard protocol in our institute for management of priaprism was to start with conservative treatment by corporal aspiration and intracorporeal injection (ICI) of phenylephrine. On the failure of conservative management, distal shunts were performed. Proximal shunts were performed on the failure of distal shunt procedures. Erectile function was evaluated with International Index of Erectile Function-5 questionnaire on admission and during follow-up.Results:All the patients had ischemic type priapism. Age of the patients ranged from 22 to 55 years. Duration of priapism varied from 20 to 480 h (mean 96.7). Etiologies attributed were; over-the-counter sildenafil use, chlorpromazine, opium intake and intracorporeal papaverine injection, chronic myeloid leukemia, and idiopathic. Five patients had preserved erectile function during follow-up. Preservation of normal erectile function following aspiration and ICI, proximal and distal shunt procedures were 66.7%, 18.1% and 20%, respectively.Conclusion:Patients with late presentation and those patients requiring higher treatment modalities (e.g., proximal shunts) for achieving detumescence will subsequently have a poor erectile function. These patients should be counseled about the early penile prosthesis placement during initial surgical management.

Sickle Cell Disease in Priapism: Disparity in Care?

To determine the effect of sickle cell disease (SCD) on hospital resource use among patients admitted for priapism. Using the Nationwide Inpatient Sample, a weighted sample of 12,547 patients was selected with a primary diagnosis of priapism from 2002 to 2011. Baseline differences for patient demographics and hospital characteristics were compared between SCD and non-SCD patients. Multivariate analysis was performed to identify the effect of SCD on length of stay, use of penile operations, blood transfusion, and cost. The proportion of SCD patients was 21.5%. SCD patients were younger, more often black, more likely to have Medicaid insurance, and treated more frequently in Southern urban teaching hospitals. SCD was a significant predictor of having a blood transfusion (odds ratio [OR], 16.3; P <.001), and an elongated length of stay (OR, 1.42; P <.001). SCD was associated with less penile operations (OR, 0.40; P <.001). When SCD patients did have an operation, it was performed later in the admission (mean, 0.87 vs 0.47 days; P <.001). SCD was not a significant predictor of increased cost (OR, 1.02; P = .869). SCD patients represent a demographically distinct subgroup of priapism patients with different patterns of resource use manifested by longer hospital stays and more blood transfusions. Moreover, despite evidence that immediate treatment of priapism results in improved erectile function outcomes, SCD patients had less surgical procedures for alleviation of acute priapism events.

PD2-07 FUNCTIONAL OUTCOMES AND FOLLOW-UP CARE AFTER PRIAPISM TREATMENT: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Penis/Testis/Urethra: Benign Disease1 Apr 2015PD2-07 FUNCTIONAL OUTCOMES AND FOLLOW-UP CARE AFTER PRIAPISM TREATMENT: A CONTEMPORARY EXPERIENCE AT A SINGLE INSTITUTION Stephen Kappa, Elizabeth Green, Shreyas Joshi, Melissa Kaufman, and Doug Milam Stephen KappaStephen Kappa More articles by this author , Elizabeth GreenElizabeth Green 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.2015.02.190AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess functional outcomes and follow-up care after priapism treatment in a contemporary cohort of patients. METHODS Retrospective review of consecutive priapism cases at a single institution from January 2005 to June 2014 was performed utilizing an inpatient Urologic Surgery consultation database. After providing informed consent, patients completed a telephone survey consisting of the International Index of Erectile Function (IIEF)-15, Erection Hardness Score (EHS), and follow-up care since their last priapism episode. RESULTS There were 102 uniquely presenting cases of priapism during the study period from a total of 62 patients. Survey data was collected on 30 priapism cases (29.4% of total cases) from 13 patients (21.0% of total patients). Mean follow-up time from last priapism case was 30.1 +/- 25.6 months. Mean IIEF-15 was 37.9 +/- 21.3, with erectile function domain score of 13.9 +/- 11.5. Mean EHS was 3.7 +/- 0.7, with 2 patients reporting no erections during the followup period. The surveyed cohort was young (mean age 31.9 +/- 11.2 years) with sickle cell disease as the most common etiology (17 cases, 56% of cohort). Sickle cell patients reported similar functional outcomes (mean IIEF-15 of +/- 37.1 +/- 21.5, with erectile function domain score of 13.9 +/- 11.5) compared to patients with other priapism etiologies (mean IIEF-15 of +/- 38.8 +/- 22.7, with erectile function domain score of 13.9 +/- 11.8). Only two patients experienced additional episodes of priapism. Hematoma was reported after 16.7% of cases. Less than half of patients (36.7%) ultimately saw a urologic surgeon in follow-up. CONCLUSIONS Long-term functional outcomes and follow-up from this large priapism case series reveals mild to moderate erectile dysfunction in a relatively young surveyed cohort with sickle cell disease as the predominant priapism etiology. Patients reported rare subsequent priapism episodes, relatively few complications after treatment, and poor urologic follow-up. This study demonstrates the feasibility of obtaining long-term follow-up data on priapism patients and provides a framework for further studies. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e42 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Stephen Kappa More articles by this author Elizabeth Green 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 ...