The 10-year priapism experience: identifying clearer targets for intervention

Abstract

Background: There is a paucity of data on the clinical experience of priapism. Moreover, little work has explored differences in practice patterns between urologists and emergency medicine (EM) physicians. Our primary objective was to understand the priapism patient population and identify targets that may guide clinical translational efforts. Methods: A retrospective chart review was performed on two priapism datasets from June 2008-July 2018-one focused on patients managed by urology and another on patients managed exclusively by EM physicians. Primary areas of interest included the duration of priapism and acute interventions during the consultation. Time to presentation, prior interventions and evaluation was also documented.Results: Over the course of 10 years, there were 396 encounters for priapism in 95 unique patients.Urology was consulted 199 times in 83 unique patients and EM physicians managed 197 encounters in 15 unique patients. In the urology cohort, median duration of priapism was 6 hours, and 72% of patients required further intervention. For the EM cohort, median duration of priapism was 4 hours and 89% of patients required further intervention. Amongst all patients, nine patients presented 4 or more times for a total of 294 encounters.Conclusions: Urology and EM managed a similar number of encounters, but EM patients had a shorter duration of priapism. Understanding the role of the EM physician and the urologist can help tailor joint curriculum efforts for initial priapism management while focusing on more complex management for urology trainees. A small proportion of patients accounted for the majority of visits secondary to recurrent ischemic priapism indicating a need to target prevention of these episodes on an outpatient basis.

Priapism: what every non-urologist should know about?

“…One mL of this solution is administered intracavernous every three to five minutes until resolution. (19). If patients do not respond, shunt surgery is the next treatment option (20).…”