Abstract and Introduction
Abstract
Background: There is a paucity of data on the clinical experience of priapism. Moreover, little work has explored differences in practice patterns between urologists and emergency medicine (EM) physicians. Our primary objective was to understand the priapism patient population and identify targets that may guide clinical translational efforts.
Methods: A retrospective chart review was performed on two priapism datasets from June 2008–July 2018—one focused on patients managed by urology and another on patients managed exclusively by EM physicians. Primary areas of interest included the duration of priapism and acute interventions during the consultation. Time to presentation, prior interventions and evaluation was also documented.
Results: Over the course of 10 years, there were 396 encounters for priapism in 95 unique patients. Urology was consulted 199 times in 83 unique patients and EM physicians managed 197 encounters in 15 unique patients. In the urology cohort, median duration of priapism was 6 hours, and 72% of patients required further intervention. For the EM cohort, median duration of priapism was 4 hours and 89% of patients required further intervention. Amongst all patients, nine patients presented 4 or more times for a total of 294 encounters.
Conclusions: Urology and EM managed a similar number of encounters, but EM patients had a shorter duration of priapism. Understanding the role of the EM physician and the urologist can help tailor joint curriculum efforts for initial priapism management while focusing on more complex management for urology trainees. A small proportion of patients accounted for the majority of visits secondary to recurrent ischemic priapism indicating a need to target prevention of these episodes on an outpatient basis.
Introduction
The healthcare burden of priapism is poorly understood and largely abstracted. In contemporary data, the incidence of priapism has been reported to be as high as 5.3 per 100,000 patients and 8 encounters per 100,000 Emergency Department (ED) visits. Additionally, some studies have shown a trend towards an increasing incidence of priapism.[1,2] Annual healthcare costs of priapism were estimated to be more than 120 million dollars. This may be an underestimate when considering the immeasurable costs such as impact on lost productivity and decreased quality of life, especially when about a quarter of patients who present for priapism will have a readmission within one year.[1,3–5]
Despite the increasing incidence of priapism, there is still a paucity of data on this patient population. Burnett notes that the healthcare consequences of priapism have received little awareness despite priapism being considered one of the worst complications of sickle cell disease.[4] Some of the largest studies include 100–200 priapism patients that each illuminate an important clinical aspect of priapism (management, prevention, erectile dysfunction outcomes), however more studies are needed to be able to understand the heterogeneity of this patient population.[6–8]
Therefore, our primary objective was to understand the priapism experience within our institution to determine targets that may guide clinical translational efforts. We further characterized the patient population to understand the differences in patients managed by urology compared to those managed by the emergency medicine (EM) physicians. We present the following article in accordance with the STROBE reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-22-180/rc).
Transl Androl Urol. 2022;11(11):1495-1502. © 2022 AME Publishing Company
