Study finds rise in hospitalizations for ischemic priapism

In a recent study published in the International Journal of Impotence Research, researchers analyze nationwide inpatient data provided by the Federal Bureau of Statistics of Germany to evaluate the in-hospital outcomes and overall trends in cases of high- and low-flow priapism. These data were used to better understand potential treatment and management measures for both conditions.

Study: Trends and outcomes of hospitalized patients with priapism in Germany: results from the GRAND study. Image Credit: Inside Creative House / Shutterstock.com

What is priapism?

Priapism is defined as an unwanted and prolonged erection that persists for many hours despite the lack of a sexual stimulus. Based on the cause and flow of blood into or out of the penis, priapism can be further classified as ischemic or non-ischemic.

Ischemic priapism is the low-flow type where venous outflow from the penis is obstructed, thus resulting in hypoxia and eventual necrosis in the corpora cavernosa. Low-flow priapism is often caused by hematological ailments such as sickle cell disease or the use of erectile agents. However, in rare cases, ischemic priapism can be caused by infections, metabolic disorders, recreational drugs, and neoplasms.

Non-ischemic or high-flow priapism occurs due to penile or perineal injury and is characterized by increased flow of blood into the penis. While ischemic priapism is always considered an emergency requiring surgical insertion of a penile shunt or implantation of a penile prosthesis, non-ischemic priapism can be managed and only requires arterial embolization in severe cases.

About the study

In the present study, researchers used German nationwide data on incidents of high- or low-flow priapism, medical procedures, and outcomes related to surgeries for all individuals hospitalized due to priapism between 2008 and 2021 to analyze trends related to priapism.

As secondary outcomes, the researchers also assessed any complications that could have occurred in the hospital, including admission into the intensive care unit (ICU) or the need for a blood transfusion. They also examined the duration of hospitalization for patients with ischemic or non-ischemic priapism.

Statistical analyses, including the chi-squared and Mann-Whitney tests, were conducted to assess the trends and compare variables between the two types of priapism. The researchers also evaluated the effects of low-priapism due to sickle cell disease and the impact of selective artery embolization after a diagnosis of high-flow priapism on hospital outcomes, such as duration of hospitalization, transfusion, or admission into the ICU. All statistical models were adjusted for confounding factors such as obesity, diabetes, and age.

Study findings

Between 2008 and 2021, 7,317 men were admitted to the hospital due to priapism, 6,588 of whom had ischemic or low-flow priapism, whereas 729 were diagnosed with non-ischemic priapism. The median age of patients with low-flow priapism was 46 years, while those with high-flow priapism were relatively younger, with a median age of 39 years.

The incidences of diabetes, hypertension, and chronic kidney disease were also higher among low-flow priapism patients as compared to those with high-flow priapism. Among the patients with ischemic priapism, 2.4% had developed the condition due to sickle cell disease. These patients were also significantly younger, with a median age of 22 years, as compared to other ischemic priapism patients, and had lower rates of chronic kidney disease, diabetes, and hypertension.

Of the 6,588 cases of ischemic priapism, 22.4% required penile shunt surgery, 2.5% of whom underwent the implantation of a penile prosthesis. Seven patients received semi-rigid prostheses, while the remaining 30 patients were implanted with inflatable prostheses.

The mortality rate among ischemic priapism patients was 1.9%, 16 of whom died after the penile shunt surgery. None of these mortalities occurred among patients with sickle cell disease.

Among patients with non-ischemic priapism, 18.7% required artery embolization. However, the median age of patients requiring artery embolization was lower than that of patients who were treated for the condition conservatively.

There were no fatalities among patients who underwent the embolization surgery. However, five patients with non-ischemic priapism died in the hospital.

Annual trends indicated that the number of ischemic priapism cases requiring hospitalization has increased since 2008, whereas the number of cases due to sickle cell disease has significantly decreased. Furthermore, while the requirement for penile shunt surgeries for ischemic priapism cases has increased from 2008 to 2021, the number of non-ischemic priapism cases requiring hospitalization has decreased significantly since 2008. The duration of hospitalization has not changed for either type of priapism.

Conclusions

Low-flow or ischemic priapism remains a serious health concern among men, with a significant increase in the requirement for hospitalization and penile shunt surgery over the last decade. Comparatively, high-flow or non-ischemic priapism has been associated with reduced hospitalization requirements and an increase in the conservative management of the condition. The incidence of sickle cell disease-related ischemic priapism has also been low.