The incidence and management of priapism in Western Australia: a 16 year audit

Abstract

The objective of the study was to conduct a retrospective audit of patients who presented with priapism in Western Australia during the years 1985-2000. We searched the records of the teaching hospitals in metropolitan Perth and those of the Keogh Institute for Medical Research for the diagnostic code for priapism. A total of 82 episodes of priapism in 63 patients occurred over this 16 year period. In all, 62 episodes occurred after intracavernosal injections (ICI) and 20 were due to other causes. Treatment of priapism included simple aspiration of blood, intracavernosal injection of a-adrenergic agents and surgical shunt procedures. Priapism occurring outside the setting of ICI was more likely to require surgery; seven of 20 episodes. After ICI therapy, eight of 62 episodes required shunts. The use of prostaglandin E1 as the drug of choice in ICI therapy in 1989 led to a fall in the incidence of ICI-induced priapism. Priapism is a major side effect of ICI therapy and an uncommon, although important, side effect of other conditions. The incidence of priapism has fallen with the introduction of prostaglandin E1 monotherapy as the favoured drug for ICI therapy of erectile failure.

Acute management of priapism in men

“…Priapism is considered as non-ischaemic if the corporal blood gas analysis is consistent with normal arterial blood gas values (pH 7.4, PO 2 > 90 mmHg, PCO 2 < 40 mmHg) [ 3 ] . Abnormalities of full blood examination, reticulocyte count and haemoglobinopathies can assist management [ 9 ] . As ischaemic priapism requires emergency intervention, these are usually the only investigations performed before initiation of treatment.…”

Incidence and clinical features of priapism in Japan: 46 cases from the Japanese diagnosis procedure combination database 2006–2008

“…The previously reported incidence of priapism varied widely because of differences in the study population and periods: 0.34-0.52 per 100 000 person-years in Finland (207 inpatients during 1975-1990), 6 0.84 in Western Australia (63 emergency room visitors during 1985-2000) 4 and 0.5 in The Netherlands (41 inpatients in 1995). 5 In Asian countries, sporadic case reports and their reviews have been published.…”

“…The present study was based on in-hospital data, and the incidence of priapism was estimated to be B0.13 per 100 000 person-years in Japan, which was lower than that in other parts of the world, as described above. [4][5][6] Because outpatient cases were not censored in the present study, the total incidence of priapism is likely to be higher. For instance, the Dutch study mentioned above made a rough estimation of the incidence in the whole population as 1.5 (95% CI, 0.2-2.8), using general practitioner registry data during 1995-1999, 5 and it implied that a threefold disparity could occur between an in-hospital database study and a general population-based study.…”

“…20 After the introduction of intracavernous injection therapy for ED in the 1980s, an increase in priapism was recognized in Finnish and Dutch studies. [4][5][6]21,22 The Dutch study found that the incidence of iatrogenic priapism as a result of treatment for ED was approximately equal to that from other causes. Today, self-injection kits are available officially in more than 80 countries including The Netherlands and Finland.…”

“…To our knowledge, only three papers have reported the incidence of priapism so far. [4][5][6] The present study evaluated the incidence of priapism and estimated its aetiology in Japan, using the Diagnosis Procedure Combination (DPC) database, a nationwide administrative database.…”