Abstract：
BACKGROUND: Priapism is a urological condition characterized by a persistent erection. The management varies based on its subclassifications. Despite established clinical guidelines for ischemic priapism, there is a lack of large-scale research focused on patient characteristics and management strategies.
OBJECTIVE: To analyze the contemporary management of ischemic priapism in the US, exploring patient demographics and clinical characteristics, as well as predictors of erectile dysfunction (ED) and penile prosthesis implantation (PPI).
METHODS: We performed a retrospective analysis of the PearlDiver Mariner database, reviewing records from 2010-2021. Adult males diagnosed with ischemic priapism were included. Data analysis covered demographic, clinical variables, and management strategies. Predictors of de novo ED and PPI were evaluated using multivariable logistic regression analysis.
RESULTS: Of 36,120 patients, most (93%) received only medical management, and a minority underwent surgical interventions (penile shunt surgery [PSS], PPI or both). Medical management was typically effective, as 67.08% of the patients in this group experienced only one episode of priapism. However, de novo ED occurred in 16.57% of these patients. The majority of patients undergoing PPI had an inflatable prosthesis (81%). Older age (odds ratio, OR 1.02), the presence of metabolic diseases (OR 1.39), neurogenic disorders (OR 1.72), solid pelvic malignancies (OR 1.09), and multiple episodes of priapism were identified as significant predictors of de novo ED (all p < 0.05). Similarly, age (OR 1.03), the presence of metabolic diseases (OR 1.23), solid pelvic malignancies (OR 1.99), and multiple episodes of priapism were associated with higher likelihood of PPI (all p < 0.05).
CONCLUSIONS: Most cases of ischemic priapism are managed with the medical therapy. Less than 3% of patients with ischemic priapism receive PPI, and when this occurs an inflatable prosthesis is favored. Age, specific comorbidities, and multiple episodes of priapism appear to be significant predictors of ED and PPI.
OBJECTIVE: To analyze the contemporary management of ischemic priapism in the US, exploring patient demographics and clinical characteristics, as well as predictors of erectile dysfunction (ED) and penile prosthesis implantation (PPI).
METHODS: We performed a retrospective analysis of the PearlDiver Mariner database, reviewing records from 2010-2021. Adult males diagnosed with ischemic priapism were included. Data analysis covered demographic, clinical variables, and management strategies. Predictors of de novo ED and PPI were evaluated using multivariable logistic regression analysis.
RESULTS: Of 36,120 patients, most (93%) received only medical management, and a minority underwent surgical interventions (penile shunt surgery [PSS], PPI or both). Medical management was typically effective, as 67.08% of the patients in this group experienced only one episode of priapism. However, de novo ED occurred in 16.57% of these patients. The majority of patients undergoing PPI had an inflatable prosthesis (81%). Older age (odds ratio, OR 1.02), the presence of metabolic diseases (OR 1.39), neurogenic disorders (OR 1.72), solid pelvic malignancies (OR 1.09), and multiple episodes of priapism were identified as significant predictors of de novo ED (all p < 0.05). Similarly, age (OR 1.03), the presence of metabolic diseases (OR 1.23), solid pelvic malignancies (OR 1.99), and multiple episodes of priapism were associated with higher likelihood of PPI (all p < 0.05).
CONCLUSIONS: Most cases of ischemic priapism are managed with the medical therapy. Less than 3% of patients with ischemic priapism receive PPI, and when this occurs an inflatable prosthesis is favored. Age, specific comorbidities, and multiple episodes of priapism appear to be significant predictors of ED and PPI.
摘要：
背景：阴茎异常勃起是一种以持续性勃起为特征的泌尿系统疾病。管理根据其子分类而有所不同。尽管建立了缺血性阴茎异常勃起的临床指南，缺乏针对患者特征和管理策略的大规模研究.
目的：分析美国缺血性阴茎异常勃起的当代管理，探索患者的人口统计学和临床特征，以及勃起功能障碍（ED）和阴茎假体植入（PPI）的预测因子。
方法：我们对PearlDiverMariner数据库进行了回顾性分析，回顾2010-2021年的记录。包括诊断为缺血性阴茎异常勃起的成年男性。数据分析涵盖人口统计，临床变量，和管理策略。使用多变量逻辑回归分析评估从头ED和PPI的预测因子。
结果：在36,120名患者中，大多数(93%)只接受医疗管理，少数人接受了手术干预(阴茎分流手术[PSS]，PPI或两者）。医疗管理通常是有效的，因为该组67.08%的患者仅经历了一次阴茎异常勃起。然而,16.57％的患者发生了新ED。大多数接受PPI的患者使用可充气假体（81％）。年龄较大(赔率比，OR1.02),代谢性疾病的存在（OR1.39），神经源性疾病（OR1.72），盆腔实性恶性肿瘤（OR1.09），和多次阴茎异常勃起发作被确定为从头ED的显著预测因子(所有p<0.05)。同样，年龄（OR1.03），代谢性疾病的存在（OR1.23），盆腔实性恶性肿瘤（OR1.99），和阴茎异常勃起的多次发作与PPI的可能性较高相关（均p<0.05）。
结论：大多数缺血性阴茎异常勃起的病例都可以通过药物治疗来治疗。不到3%的缺血性阴茎异常勃起患者接受PPI，当这种情况发生时，充气假体是有利的。年龄,特定的合并症，多次阴茎异常勃起似乎是ED和PPI的重要预测因素。
目的：分析美国缺血性阴茎异常勃起的当代管理，探索患者的人口统计学和临床特征，以及勃起功能障碍（ED）和阴茎假体植入（PPI）的预测因子。
方法：我们对PearlDiverMariner数据库进行了回顾性分析，回顾2010-2021年的记录。包括诊断为缺血性阴茎异常勃起的成年男性。数据分析涵盖人口统计，临床变量，和管理策略。使用多变量逻辑回归分析评估从头ED和PPI的预测因子。
结果：在36,120名患者中，大多数(93%)只接受医疗管理，少数人接受了手术干预(阴茎分流手术[PSS]，PPI或两者）。医疗管理通常是有效的，因为该组67.08%的患者仅经历了一次阴茎异常勃起。然而,16.57％的患者发生了新ED。大多数接受PPI的患者使用可充气假体（81％）。年龄较大(赔率比，OR1.02),代谢性疾病的存在（OR1.39），神经源性疾病（OR1.72），盆腔实性恶性肿瘤（OR1.09），和多次阴茎异常勃起发作被确定为从头ED的显著预测因子(所有p<0.05)。同样，年龄（OR1.03），代谢性疾病的存在（OR1.23），盆腔实性恶性肿瘤（OR1.99），和阴茎异常勃起的多次发作与PPI的可能性较高相关（均p<0.05）。
结论：大多数缺血性阴茎异常勃起的病例都可以通过药物治疗来治疗。不到3%的缺血性阴茎异常勃起患者接受PPI，当这种情况发生时，充气假体是有利的。年龄,特定的合并症，多次阴茎异常勃起似乎是ED和PPI的重要预测因素。
