Date Published: July 3, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Henry P. Gottsch, Richard E. Berger, Claire C. Yang.
Objective. The goal of this study is to describe comorbid characteristics in patients who have priapism, and their treatment outcomes. Methods. Chart review was undertaken on men who had a diagnosis of priapism from a tertiary medical center, from 2000–2010. Men with priapism due exclusively to the use of prescription erectile aids and medications were not included in the review. Results. We identified 79 patients with the priapism. The most common type of priapism was the low flow variant. High flow priapism was identified in 2 patients. The most common general comorbid condition associated with priapism was mental illness (including substance abuse), which was present in 56% of the patients. Neurogenic priapism accounted for 19% of the total priapism events. Psychopharmaceutical agents and recreational drugs were commonly associated with ischemic priapism. Acute complications of priapism treatment were not common, but long-term complications, especially erectile dysfunction, were frequent. Conclusions. We describe the characteristics and outcomes of a large group of patients with priapism. Our experience at a tertiary care center indicates that mental illness, including substance abuse disorders, is a highly prevalent comorbid condition in men who experience priapism. Consistent with previous reports, erectile dysfunction is the most common complication from priapism and its treatment, occurring in the majority of men.
Priapism is a relatively uncommon occurrence and as a result, there is scant contemporary literature on the associated medical conditions of men who experience priapism. The occurrence of priapism and its treatment have been historically reported in small case series, and this literature was comprehensively reviewed in aggregate by an expert panel of American Urological Association in 2003 and reconfirmed in 2010 . There are well-recognized associations between priapism and predisposing factors such as hematologic disorders and particular medications, but better understanding of other characteristics of affected men could potentially aid in their management. The objective of this retrospective review is to report on a contemporary cohort of men presenting to a tertiary care medical center with priapism, describing comorbidities and treatment outcomes.
The data for this study was drawn from a tertiary care center comprised of a university hospital and a level I trauma center/county hospital. The hospitals’ Institutional Review Board approved this study. We searched hospital billing records from 2000–2010 for ICD-9 code (607.3) for priapism. Medical record review was undertaken on men who had a diagnosis of priapism, with particular focus on cause of priapism, concomitant comorbid conditions, interventions to treat priapism, and subsequent complications and sequelae. A clinical diagnosis of priapism was made based on a history and physical examination, with a penile blood gas performed in most cases. Comorbid conditions were determined through chart review. Patients who were seen with priapism due to physician-prescribed erectile dysfunction (ED) treatment were excluded from this cohort. Mental health disorders were included as comorbid conditions if they were previously documented in the medical record. Substance abuse was considered as a mental health disorder and was noted if there was preceding history of emergency room visits, medical treatment, positive toxicology screen (not available on all patients), or disability associated with substance abuse. Duration of use and timing of substance abuse in relation to the priapism event was not available.
This retrospective review is one of the largest contemporary series of priapism, and we have identified several novel findings. Our primary objective was to identify pertinent comorbidities. We found a high prevalence of mental illness in patients presenting with priapism (56%), with substance abuse as the most common mental health disorder. The secondary objective of the study was to assess outcomes of procedures to treat ischemic priapism. In the current study, poor followup was common, with only 44% of patients seen in clinic after the resolution of priapism. In general, return of erectile function was quite limited.
We describe the characteristics and outcomes of a large group of patients with priapism. Our experience at a tertiary care center indicates that mental illness, including substance abuse disorders, is a highly prevalent comorbid condition in men who experience priapism. Consistent with previous reports, erectile dysfunction is the most common complication from priapism and its treatment, occurring in the majority of men.