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Conservative and medical treatments of non-sickle cell disease-related ischemic priapism: a systematic review by the EAU Sexual and Reproductive Health Panel

International Journal of Impotence Research volume 36, pages 6–19 (2024)Cite this article

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Abstract

Conservative and medical treatments are considered the first step in ischemic priapism (IP) management, although there is no clear evidence regarding their efficacy. We conducted a systematic review on behalf of the EAU Guidelines panel on Sexual and Reproductive health to analyse the available evidence on the efficacy and safety of conservative and medical treatment for non-sickle cell disease-related IP. Databases searched for relevant literature investigating efficacy and safety of conservative measures and medical treatment for IP included Medline, EMBASE, Cochrane Libraries and clinicaltrial.gov published up to September 2021. Overall, 41 retrospective, 3 prospective single-arm studies and 3 randomized controlled trials met the inclusion criteria. Intracavernous injection with sympathomimetic (ICIs) agents were the most frequently utilized treatment with efficacy ranging from 0 to 100% of cases. The combination of ICIs with corporeal aspiration with or without irrigation with saline was successful in 70 to 100% of cases. Oral treatment with β2 receptor agonist (e.g., terbutaline) showed mild to moderate efficacy. Conservative methods including ice pack, exercise, cold enema and ejaculation depicted lower effectiveness in resolving priapism (1–55%). Longer time interval from the onset to the resolution of IP was associated with higher rate of erectile dysfunction at follow-up (30–70%), especially after 24 h.

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Data are available from the corresponding author on reasonable request.

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Acknowledgements

Julie Darraugh and Karin Plass, for their constant support from the EAU Guidelines Office. This Systematic Review was performed under the auspices of the: European Association of Urology Guidelines Office Board; European Association of Urology Sexual & Reproductive Health Guidelines Panel.

Funding

This study is funded by European Association of Urology.

Author information

Author notes

  1. These authors contributed equally: Andrea Salonia, Suks Minhas.

Authors and Affiliations

  1. Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy

    Paolo Capogrosso

  2. Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK

    Kostas Dimitropolous

  3. Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK

    Kostas Dimitropolous

  4. Urology Section, Department of Surgery, University of Catania, Catania, Italy

    Giorgio Ivan Russo

  5. Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, UK

    Tharu Tharakan & Suks Minhas

  6. Section of Investigative Medicine, Department of Medicine, Imperial College London, London, UK

    Tharu Tharakan

  7. Department of Urology, University Hospitals Leuven, Leuven, Belgium

    Uros Milenkovic

  8. Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy

    Andrea Cocci

  9. Department of Urology, Foundation IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Luca Boeri

  10. School of Medicine, Department of Urology, Selcuk University, Konya, Turkey

    Murat Gül

  11. Department of Urology, University of Foggia, Foggia, Italy

    Carlo Bettocchi

  12. CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal

    Joana Carvalho

  13. Department of Urology, Taksim Training & Research Hospital, Instanbul, Turkey

    Arif Kalkanlı

  14. Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy

    Giovanni Corona

  15. Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany

    Georgios Hatzichristodoulou

  16. Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK

    Hugh T. Jones

  17. Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey

    Ates Kadioglu

  18. Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda. Lyx Institute of Urology. Universidad Francisco de Vitoria, Madrid, Spain

    Juan Ignacio Martinez-Salamanca

  19. Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, UK

    Vaibhav Modgil

  20. Department of Urology, Biruni University School of Medicine, Istanbul, Turkey

    Ege Can Serefoglu

  21. Department of Medicine and Surgery “Scuola Medica Salernitana”, University of Salerno, Fisciano, Campania, Italy

    Paolo Verze

  22. Division of Experimental Oncology/Unit of Urology; URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Andrea Salonia

  23. University Vita-Salute San Raffaele, Milan, Italy

    Andrea Salonia

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  1. Paolo Capogrosso
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Consortia

on behalf of the EAU Working Group on Sexual and Reproductive Health

Contributions

KD, AS and SM were responsible for designing the review protocol and writing the protocol; PC, was responsible for writing the report; PC, TT, UM, AC, LB, MG, VM, GH were responsible for conducting the search, screening potentially eligible studies, extracting and analysing data, interpreting results. CB, ArK, GC, HJ, AK, and JMS contributed to designing the review and provided feedback on the report.

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Correspondence to Andrea Salonia.

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Capogrosso, P., Dimitropolous, K., Russo, G.I. et al. Conservative and medical treatments of non-sickle cell disease-related ischemic priapism: a systematic review by the EAU Sexual and Reproductive Health Panel. Int J Impot Res 36, 6–19 (2024). https://doi.org/10.1038/s41443-022-00592-2

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