Clinical Outcomes of Periprocedural Antithrombotic Therapy in Ischemic Priapism Management

Joris J. Ramstein, Austin Lee, Andrew J. Cohen, Nnenaya A. Mmonu, Natalie Rios, Anthony Enriquez, Alan W. Shindel, Tom F. Lue, Benjamin N. Breyer

Research output: Contribution to journalArticle

Abstract

Background: Priapism is a urologic emergency consisting of a painful erection lasting greater than 4 hours; antithrombotic therapy (ATT) have recently been recommended as an adjunct in the treatment of ischemic priapism. Aim: To determine the short- and long-term outcomes of periprocedural ATT in the management of acute ischemic priapism. Methods: A retrospective review of patients seen at the University of California, San Francisco, from 2008 to 2019 was carried out to identify those evaluated for acute priapism. Information regarding duration of priapism, etiology, treatment, periprocedural and postprocedural ATT type and dose, and follow-up data was collected. Outcomes: ATT use was the exposure of interest; outcome variables included priapism resolution, repeat episodes, long-term complications, and follow-up. Results: 70 patients with at least 1 detailed record of an acute priapism episode between 2008 and 2019 were identified. Of the 70 patients who underwent management for an acute episode of priapism, 59 (84%) received intracavernous injection of phenylephrine with or without corporal aspiration. Of the 4 patients who received ATT at the same time as intracavernous injection, none had additional priapism episodes. In the 55 patients who did not receive immediate ATT, 22 (40%) required at least 1 shunting procedure. The 9 patients who received ATT concurrently with shunting experienced less recurrence than the 13 patients who did not receive ATT (11% vs 69%, respectively P =.012). There were no significant differences in long-term erectile dysfunction (P =.627), fibrosis (P =.118), genitourinary pain (P =.474), and urinary issues (P =.158) between those who received ATT and those who did not. Clinical Implications: Our findings suggest that ATT has a role in preventing priapism recurrence; we observed that long-term repeat priapism episodes are less frequent in those who received periprocedural ATT compared with those who did not and that ATT may especially reduce recurrence in cases when shunting was required Strengths & Limitations: This is the first study looking at the clinical outcomes of periprocedural ATT in the management of ischemic priapism. It is limited by the fact that it is a single-center study, types of ATT were heterogenous, and the exact timing of priapism management could not be measured for everyone. Conclusion: In spite of its limitations, these preliminary findings are promising and warrant further exploration of the use of ATT in the management of ischemic priapism. Ramstein JJ, Lee A, Cohen AJ, et al. Clinical Outcomes of Periprocedural Antithrombotic Therapy in Ischemic Priapism Management. J Sex Med 2020;XX:XXX–XXX.

Original languageEnglish (US)
JournalJournal of Sexual Medicine
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • Anticoagulation
  • Priapism
  • Sexual Dysfunction
  • Surgical Management

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology
  • Urology

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  • Cite this

    Ramstein, J. J., Lee, A., Cohen, A. J., Mmonu, N. A., Rios, N., Enriquez, A., Shindel, A. W., Lue, T. F., & Breyer, B. N. (Accepted/In press). Clinical Outcomes of Periprocedural Antithrombotic Therapy in Ischemic Priapism Management. Journal of Sexual Medicine. https://doi.org/10.1016/j.jsxm.2020.07.013