Risk Factors for Priapism Readmission
Wilson Sui, BA; Ifeanyi C. Onyeji, BA; Maxwell B. James, BA; Peter J. Stahl, MD; Arindam RoyChoudhury, PhD; Christopher B. Anderson, MD
ONLINE: August 2016 – The Journal of Sexual Medicine
Introduction and Goal
Priapism – an erection lasting four hours or more without sexual stimulation – is a medical emergency that has not been widely studied.
Sickle cell disease (SCD) is one of the strongest risk factors for priapism, accounting to 11% to 42% of events. Other common risk factors include drug and alcohol abuse, trauma, spinal cord injury, and medication use.
Often, priapism patients are young and prone to recurrence. The goal of this study was to “characterize and identify independent predictors for priapism readmission.”
Data from the New York Statewide Planning and Research Cooperative System (SPARCS) were used in this study. This database includes information on hospital inpatient stays, ambulatory surgery encounters, and emergency department visits in the state of New York.
The study subjects were all patients who had been seen in an emergency department for priapism between 2005 and 2014. Trauma patients were excluded. Subjects were followed for one year to track readmissions, defined as additional hospital admissions or emergency department visits. Treatments used at each encounter were also noted.
The researchers identified 3,372 men who went to the emergency department for priapism:
• Average age on first presentation was 39 years.
• Almost 40% of the men were black. Forty-one percent were white and 19% identified as another race.
• About 15% had SCD, while 16% had a history of drug use, and almost 20% had comorbid psychiatric disease.
During the 12 months following the first visit, 24% of the men were readmitted at least once. Over two-thirds of the readmissions occurred during the first 60 days. About 56% were readmitted once; 15% were readmitted more than three times.
Readmitted patients tended to be younger, black, and were more likely to have a priapism risk factor and less likely to present with a first time admission.
Almost three-quarters of the men received supportive care (no procedure to treat priapism) during their first encounter, although the authors noted that surgical and non-surgical treatment procedures might not have been fully captured due to the way in which the data were reported.
The most significant risk factors for readmission were the following:
• Sickle cell disease
• Drug abuse or psychiatric disease
• History of erectile dysfunction
• Medical insurance that was not commercial
• An inpatient admission for the first priapism event
Up to 64% of men with SCD develop priapism, as the sickling of blood cells induces “poor venous outflow.” Fibrosis and ED can result from recurrences of ischemic priapism. Possible methods for preventing priapism in SCD patients include medications, blood transfusions, and avoiding inciting events.
Sixteen percent of the men in this study had a history of drug abuse, and the authors pointed out that Ecstasy and cocaine have been associated with priapism.
Medications for psychiatric disease, such as antidepressants, antipsychotics, and anxiolytics have also been linked to priapism. Men who take these drugs should know that recurrent priapism is possible. Clinicians treating these patients might consider changing medications or treatment approaches.
The authors noted that ED was also a risk factor for priapism readmission. They explained that the risk of priapism for men using oral PDE5 inhibitors for ED was “exceedingly low” and that men in this category may be more likely to use intracavernosal injections as an ED therapy. Priapism risks associated with injections may be reduced through “proper in-office training programs involving test dosing” for patients.
The authors acknowledged several limitations, which included the following:
• They did not know whether the men had ischemic or arterial priapism.
• There was no way to determine whether men had recurring priapism episodes without visiting an emergency department. Therefore, rates of priapism recurrence could be higher than those reflected in this study.
• It was unknown whether patients taking medications for ED or psychiatric disease were being treated with drugs specifically associated with priapism.
Based on these findings, the authors suggested that “Providers should attempt to identify patients at high risk of recurrence to offer better counseling on potential inciting events and possible methods to avoid or prevent recurrence.