Abstract：
BACKGROUND: Refractory priapism, characterized by persistent and prolonged painful erections despite initial treatment maneuvers, can significantly impair erectile function secondary to ischemia-induced corporal tissue fibrosis. These patients will likely require subsequent penile prosthesis (PP) surgery to regain sexual activity, yet consensus regarding the optimal timing of implantation remains lacking.
OBJECTIVE: To evaluate and compare the clinical outcomes associated with early vs delayed PP implantation in individuals with priapism-induced erectile dysfunction (ED).
METHODS: We included studies that focused on refractory priapism leading to ED and its management with PP implantation. We assessed cohort study bias with a risk-of-bias tool and case series bias with the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated by a fixed-effect model.
RESULTS: We included 9 studies, comprising 4 cohort studies and 5 case series, involving a total of 278 patients. Total complications were higher in the delayed group (OR, 4.16; 95% CI, 2.77-6.26). Fibrosis was significantly more pronounced in the delayed group (OR, 118.18; 95% CI, 20.06-696.32). The odds of erosion, infections, and penile injury did not show statistically significant differences between the groups (OR, 2.52 [95% CI, 0.67-9.49], 0.89 [0.38-2.10], 1.83 [0.79-4.26], respectively). Patients\' satisfaction resulted in a pooled OR of 0.15 (95% CI, 0.04-0.49) in favor of the early PP insertion group.
CONCLUSIONS: The results from this study favor an early approach to ED (within 30 days) following ischemic priapism. However, it is important to consider patients\' preferences, values, and psychological factors to make an informed decision.
OBJECTIVE: To evaluate and compare the clinical outcomes associated with early vs delayed PP implantation in individuals with priapism-induced erectile dysfunction (ED).
METHODS: We included studies that focused on refractory priapism leading to ED and its management with PP implantation. We assessed cohort study bias with a risk-of-bias tool and case series bias with the modified Newcastle-Ottawa Scale. Pooled odds ratios (ORs) were calculated by a fixed-effect model.
RESULTS: We included 9 studies, comprising 4 cohort studies and 5 case series, involving a total of 278 patients. Total complications were higher in the delayed group (OR, 4.16; 95% CI, 2.77-6.26). Fibrosis was significantly more pronounced in the delayed group (OR, 118.18; 95% CI, 20.06-696.32). The odds of erosion, infections, and penile injury did not show statistically significant differences between the groups (OR, 2.52 [95% CI, 0.67-9.49], 0.89 [0.38-2.10], 1.83 [0.79-4.26], respectively). Patients\' satisfaction resulted in a pooled OR of 0.15 (95% CI, 0.04-0.49) in favor of the early PP insertion group.
CONCLUSIONS: The results from this study favor an early approach to ED (within 30 days) following ischemic priapism. However, it is important to consider patients\' preferences, values, and psychological factors to make an informed decision.
摘要：
背景：难治性阴茎异常勃起，尽管进行了初步治疗，但其特征是持续和长时间的疼痛性勃起，可以显著损害勃起功能继发于缺血诱导的身体组织纤维化。这些患者可能需要随后的阴茎假体（PP）手术以恢复性活动，然而对于最佳植入时机仍缺乏共识.
目的：评估和比较阴茎异常勃起（ED）患者早期与延迟PP植入的临床结局。
方法：我们纳入的研究集中于导致ED的难治性阴茎异常勃起和PP植入治疗。我们使用偏倚风险工具评估队列研究偏倚，并使用改良的纽卡斯尔-渥太华量表评估病例系列偏倚。通过固定效应模型计算集合赔率比(OR)。
结果：我们纳入了9项研究，包括4个队列研究和5个病例系列，共涉及278名患者。延迟组的总并发症较高(OR,4.16；95%CI，2.77-6.26）。纤维化在延迟组中明显更明显（OR，118.18；95%CI，20.06-696.32）。侵蚀的几率，感染,和阴茎损伤在两组之间没有统计学上的显著差异(OR，2.52[95%CI，0.67-9.49]，0.89[0.38-2.10],1.83[0.79-4.26],分别)。患者的满意度导致合并OR为0.15（95％CI，0.04-0.49），有利于早期PP插入组。
结论：这项研究的结果有利于缺血性阴茎异常勃起后（30天内）早期治疗ED。然而,重要的是要考虑病人的喜好，值,和心理因素做出明智的决定。
目的：评估和比较阴茎异常勃起（ED）患者早期与延迟PP植入的临床结局。
方法：我们纳入的研究集中于导致ED的难治性阴茎异常勃起和PP植入治疗。我们使用偏倚风险工具评估队列研究偏倚，并使用改良的纽卡斯尔-渥太华量表评估病例系列偏倚。通过固定效应模型计算集合赔率比(OR)。
结果：我们纳入了9项研究，包括4个队列研究和5个病例系列，共涉及278名患者。延迟组的总并发症较高(OR,4.16；95%CI，2.77-6.26）。纤维化在延迟组中明显更明显（OR，118.18；95%CI，20.06-696.32）。侵蚀的几率，感染,和阴茎损伤在两组之间没有统计学上的显著差异(OR，2.52[95%CI，0.67-9.49]，0.89[0.38-2.10],1.83[0.79-4.26],分别)。患者的满意度导致合并OR为0.15（95％CI，0.04-0.49），有利于早期PP插入组。
结论：这项研究的结果有利于缺血性阴茎异常勃起后（30天内）早期治疗ED。然而,重要的是要考虑病人的喜好，值,和心理因素做出明智的决定。
