Androgen Blockade for the Treatment of High-Flow Priapism

Kuwong B. Mwamukonda, Thomas Chi, Alan W. Shindel, Tom F. Lue

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Introduction: High-flow priapism (HFP) may occur secondary to perineal trauma, congenital arterial malformations, and iatrogenic insults. In cases that do not resolve spontaneously, standard management is by selective embolization, resulting in resolution rates as high as 78%; however, erectile dysfunction (ED) is a frequent complication, occurring in up to 39% of cases. Aim: We report our use of androgen blockade (AB) to suppress nocturnal erections as an alternative treatment for HFP. Methods: A retrospective review of all patients treated at our institution for HFP was undertaken. Included in this study were any patients treated with single- or combination-agent AB for HFP. Operative reports and medical records were examined to determine patient characteristics and outcomes. Treatment efficacy, side effects, and residual ED were assessed using a questionnaire. Main Outcome Measures: The primary clinical outcomes assessed were resolution of HFP, tolerability, and side effects of treatment. Results: Seven patients with HFP were treated with AB. Priapism was a result of trauma in three patients and a persistent high-flow state after shunt procedures in four. Mean follow-up was 2 years (range 4 to 64 months). Therapy consisted primarily of 7.5 mg intramuscular monthly leuprolide injections, although bicalutamide and ketoconazole were also utilized as adjunct treatments. Therapy duration ranged from 2 months to 6 months and was discontinued after symptom resolution. One patient discontinued daily ketoconazole after 1 week because of severe hot flashes. The remaining six patients reported complete resolution of HFP. The primary complaints during therapy were decreased libido and fatigue. All patients reported some degree of ED during therapy. There was no reported residual ED or other hypogonadal symptoms on withdrawal of therapy. Conclusion: AB is a successful option for treating HFP with acceptable side effects and return to baseline potency on treatment withdrawal. Mwamukonda KB, Chi T, Shindel AW, and Lue TF. Androgen blockade for the treatment of high-flow priapism. J Sex Med 2010;7:2532-2537.

Original languageEnglish (US)
Pages (from-to)2532-2537
Number of pages6
JournalJournal of Sexual Medicine
Volume7
Issue number7
DOIs
StatePublished - Jul 2010

Fingerprint

Priapism
Androgens
Erectile Dysfunction
Therapeutics
Ketoconazole
Hot Flashes
Leuprolide
Libido
Substance Withdrawal Syndrome
Wounds and Injuries
Medical Records
Fatigue
Outcome Assessment (Health Care)

Keywords

  • Androgen Deprivation
  • Erectile Dysfunction
  • High-Flow Priapism
  • Nonischemic Priapism
  • Prolonged Erection

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Androgen Blockade for the Treatment of High-Flow Priapism. / Mwamukonda, Kuwong B.; Chi, Thomas; Shindel, Alan W.; Lue, Tom F.

In: Journal of Sexual Medicine, Vol. 7, No. 7, 07.2010, p. 2532-2537.

Research output: Contribution to journalArticle

Mwamukonda, Kuwong B. ; Chi, Thomas ; Shindel, Alan W. ; Lue, Tom F. / Androgen Blockade for the Treatment of High-Flow Priapism. In: Journal of Sexual Medicine. 2010 ; Vol. 7, No. 7. pp. 2532-2537.
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abstract = "Introduction: High-flow priapism (HFP) may occur secondary to perineal trauma, congenital arterial malformations, and iatrogenic insults. In cases that do not resolve spontaneously, standard management is by selective embolization, resulting in resolution rates as high as 78{\%}; however, erectile dysfunction (ED) is a frequent complication, occurring in up to 39{\%} of cases. Aim: We report our use of androgen blockade (AB) to suppress nocturnal erections as an alternative treatment for HFP. Methods: A retrospective review of all patients treated at our institution for HFP was undertaken. Included in this study were any patients treated with single- or combination-agent AB for HFP. Operative reports and medical records were examined to determine patient characteristics and outcomes. Treatment efficacy, side effects, and residual ED were assessed using a questionnaire. Main Outcome Measures: The primary clinical outcomes assessed were resolution of HFP, tolerability, and side effects of treatment. Results: Seven patients with HFP were treated with AB. Priapism was a result of trauma in three patients and a persistent high-flow state after shunt procedures in four. Mean follow-up was 2 years (range 4 to 64 months). Therapy consisted primarily of 7.5 mg intramuscular monthly leuprolide injections, although bicalutamide and ketoconazole were also utilized as adjunct treatments. Therapy duration ranged from 2 months to 6 months and was discontinued after symptom resolution. One patient discontinued daily ketoconazole after 1 week because of severe hot flashes. The remaining six patients reported complete resolution of HFP. The primary complaints during therapy were decreased libido and fatigue. All patients reported some degree of ED during therapy. There was no reported residual ED or other hypogonadal symptoms on withdrawal of therapy. Conclusion: AB is a successful option for treating HFP with acceptable side effects and return to baseline potency on treatment withdrawal. Mwamukonda KB, Chi T, Shindel AW, and Lue TF. Androgen blockade for the treatment of high-flow priapism. J Sex Med 2010;7:2532-2537.",
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N2 - Introduction: High-flow priapism (HFP) may occur secondary to perineal trauma, congenital arterial malformations, and iatrogenic insults. In cases that do not resolve spontaneously, standard management is by selective embolization, resulting in resolution rates as high as 78%; however, erectile dysfunction (ED) is a frequent complication, occurring in up to 39% of cases. Aim: We report our use of androgen blockade (AB) to suppress nocturnal erections as an alternative treatment for HFP. Methods: A retrospective review of all patients treated at our institution for HFP was undertaken. Included in this study were any patients treated with single- or combination-agent AB for HFP. Operative reports and medical records were examined to determine patient characteristics and outcomes. Treatment efficacy, side effects, and residual ED were assessed using a questionnaire. Main Outcome Measures: The primary clinical outcomes assessed were resolution of HFP, tolerability, and side effects of treatment. Results: Seven patients with HFP were treated with AB. Priapism was a result of trauma in three patients and a persistent high-flow state after shunt procedures in four. Mean follow-up was 2 years (range 4 to 64 months). Therapy consisted primarily of 7.5 mg intramuscular monthly leuprolide injections, although bicalutamide and ketoconazole were also utilized as adjunct treatments. Therapy duration ranged from 2 months to 6 months and was discontinued after symptom resolution. One patient discontinued daily ketoconazole after 1 week because of severe hot flashes. The remaining six patients reported complete resolution of HFP. The primary complaints during therapy were decreased libido and fatigue. All patients reported some degree of ED during therapy. There was no reported residual ED or other hypogonadal symptoms on withdrawal of therapy. Conclusion: AB is a successful option for treating HFP with acceptable side effects and return to baseline potency on treatment withdrawal. Mwamukonda KB, Chi T, Shindel AW, and Lue TF. Androgen blockade for the treatment of high-flow priapism. J Sex Med 2010;7:2532-2537.

AB - Introduction: High-flow priapism (HFP) may occur secondary to perineal trauma, congenital arterial malformations, and iatrogenic insults. In cases that do not resolve spontaneously, standard management is by selective embolization, resulting in resolution rates as high as 78%; however, erectile dysfunction (ED) is a frequent complication, occurring in up to 39% of cases. Aim: We report our use of androgen blockade (AB) to suppress nocturnal erections as an alternative treatment for HFP. Methods: A retrospective review of all patients treated at our institution for HFP was undertaken. Included in this study were any patients treated with single- or combination-agent AB for HFP. Operative reports and medical records were examined to determine patient characteristics and outcomes. Treatment efficacy, side effects, and residual ED were assessed using a questionnaire. Main Outcome Measures: The primary clinical outcomes assessed were resolution of HFP, tolerability, and side effects of treatment. Results: Seven patients with HFP were treated with AB. Priapism was a result of trauma in three patients and a persistent high-flow state after shunt procedures in four. Mean follow-up was 2 years (range 4 to 64 months). Therapy consisted primarily of 7.5 mg intramuscular monthly leuprolide injections, although bicalutamide and ketoconazole were also utilized as adjunct treatments. Therapy duration ranged from 2 months to 6 months and was discontinued after symptom resolution. One patient discontinued daily ketoconazole after 1 week because of severe hot flashes. The remaining six patients reported complete resolution of HFP. The primary complaints during therapy were decreased libido and fatigue. All patients reported some degree of ED during therapy. There was no reported residual ED or other hypogonadal symptoms on withdrawal of therapy. Conclusion: AB is a successful option for treating HFP with acceptable side effects and return to baseline potency on treatment withdrawal. Mwamukonda KB, Chi T, Shindel AW, and Lue TF. Androgen blockade for the treatment of high-flow priapism. J Sex Med 2010;7:2532-2537.

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KW - Nonischemic Priapism

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