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Emergency room visits are reduced in patients using type 5 phosphodiesterase inhibitors for recurrent priapism

Rajih, E1; Campbell, J2; Burnett, AL2

1: Taibah University, Saudi Arabia; 2: Johns Hopkins Hospital, United States

Objective: A treatment protocol involving type 5 Phosphodiesterase inhibitor (PDE5i) represents a new evolving therapy for recurrent ischemic priapism. Previous observations have encouraged further studies to evaluate treatment effects in larger studies and with longer-term follow-up. The purpose of this study was to evaluate the real world experience of PDE5i in managing recurrent priapism.

Material and Methods: A retrospective analysis of the Johns Hopkins Hospital institutional database of priapism management from May 2006 to March 2017 consisted of 18 patients, who had recurrent ischemic priapism managed with a PDE5i treatment protocol. Inclusion criteria were the occurrence of at least 4 priapism episodes per month. Exclusion criteria included incomplete follow-up. The treatment protocol was early morning low dose 25 to 50 mg sildenafil. Baseline clinical characteristics, treatment effect, and compliance were documented. The primary outcome was emergency room visits with and without PDE5i treatment.

Results: The mean age was 30.1 +/-12.8 years. PDE5i treatment reduced the occurrence of emergency room visits in 12/14 patients (85.7%) whereas the other 4 patients did not have any emergency room visits prior to or after treatment. It decreased the mean monthly priapism episodes from 13.8+/-11 to 4.05+/-6.6 (p=0.002). Subjective improvement was reported in 16 patients (88.9%). At a median follow up of 8 months (IQR 4-60), 10 patients (55.6%) continued on treatment during follow-up whereas 8 patients (44.4%) discontinued treatment after 3 months due to lack of insurance coverage. A total of seven patients out of eight who discontinued the treatment reported similar pretreatment episodic priapism.

Conclusions: Sildenafil reduced overall emergency visits and frequency of ischemic priapic episodes. The majority of patients elected to continue on treatment for long terms. Although we found a significant improvement in patients condition overall, treatment expense represents the major obstacle for treatment continuity in our patients.

Disclosure:

Work supported by industry: no. The presenter or any of the authors act as a consultant, employee (part time or full time) or shareholder of an industry.

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