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A population-based analysis of predictors of penile surgical intervention among inpatients with acute priapism

International Journal of Impotence Research volume 35, pages 107–113 (2023)Cite this article

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Abstract

While consensus exists regarding risk factors for priapism, predictors of operative intervention are less well established. We assessed patient and hospital-level predictors associated with penile surgical intervention (PSI) for patients admitted with acute priapism, as well as length of stay (LOS) and total hospital charges using the National Inpatient Sample (2010–2015). Inpatients with acute priapism were stratified by PSI, defined as penile shunts, incisions, and placement of penile prostheses, exclusive of irrigation procedures. Survey-weighted logistic regression models were utilized to assess predictors of PSI. Negative binomial regression and generalized linear models with logarithmic transformation were used to compare PSI to LOS and total hospital charges, respectively. Among 14,529 weighted hospitalizations, 4,953 underwent PSI. Non-Medicare insurances, substance abuse, and ≥3 Elixhauser comorbidities had increased odds of PSI. Conversely, Black patients, sickle cell disease, alcohol abuse, neurologic diseases, malignancies, and teaching hospitals had lower odds. PSI coincided with shorter median LOS (adjusted IRR: 0.62; p < 0.001) and lower ratio of the mean hospital charges (adjusted Ratio: 0.49; p < 0.001). Additional subgroup analysis revealed penile incisions and shunts primarily associated with reduced LOS (adjusted IRR: 0.66; p < 0.001) and total hospital charges (adjusted Ratio: 0.49; p < 0.001). Further work is required to understand predictors of poor outcomes in these populations.

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References

  1. Salonia A, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Vardi Y, et al. European association of urology guidelines on priapism. Eur Urol. 2014;65:480–489.

    Article  PubMed  Google Scholar 

  2. Bivalacqua TJ, Allen BK, Brock G, Broderick GA, Kohler TS, Mulhall JP, et al. Acute ischemic priapism: An AUA/SMSNA Guideline. J Urol. 2021;206(Nov):1114–21.

    Article  PubMed  Google Scholar 

  3. Roghmann F, Becker A, Sammon JD, Ouerghi M, Sun M, Sukumar S, et al. Incidence of priapism in emergency departments in the United States. J Urol. 2013;190:1275–80.

    Article  PubMed  Google Scholar 

  4. Stein DM, Flum AS, Cashy J, Zhao LC, McVary KT. Nationwide emergency department visits for priapism in the United States. J Sex Med. 2013;10:2418–22.

    Article  PubMed  Google Scholar 

  5. Ralph DJ, Garaffa G, Muneer A, Freeman A, Rees R, Christopher AN, et al. The immediate insertion of a penile prosthesis for acute ischaemic priapism. Eur Urol. 2009;56:1033–8.

    Article  PubMed  Google Scholar 

  6. Kulmala RV, Lehtonen TA, Tammela TLJ. Priapism, its incidence and seasonal distribution in Finland. Scand J Urol Nephrol. 2010;29:93–96.

    Article  Google Scholar 

  7. Earle C, Stuckey B, Ching H, Wisniewski Z. The incidence and management of priapism in Western Australia: a 16 year audit. Int J Impot Res. 2003;15:272–6.

    Article  CAS  PubMed  Google Scholar 

  8. Broderick GA. Priapism and Sickle‐cell anemia: diagnosis and nonsurgical therapy. J Sex Med. 2012;9:88–103.

    Article  CAS  PubMed  Google Scholar 

  9. Scherzer ND, Reddy AG, Le TV, Chernobylsky D, Hellstrom WJG. Unintended consequences: a review of pharmacologically-induced priapism. Sex Med Rev. 2019;7:283–92.

    Article  PubMed  Google Scholar 

  10. Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, Shamloul R. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010;7:476–500.

    Article  PubMed  Google Scholar 

  11. Zhao H, Dallas K, Masterson J, Lo E, Houman J, Berdahl C, et al. Risk factors for surgical shunting in a large cohort with ischemic priapism. J Sex Med. 2020;17:2472–7.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Masterson TA, Parmar M, Tradewell MB, Nackeeran S, Rainer Q, Blachman-Braun R, et al. Using artificial intelligence to predict surgical shunts in men with ischemic priapism. J Urol. 2020;204:1033–8.

    Article  PubMed  Google Scholar 

  13. Ahmed M, Augustine B, Matthew M, Awaisu M, Sudi A, Hamza KB, et al. Prognostic factors and outcome of management of ischemic priapism in Zaria, Nigeria. Niger J Surg. 2017;23:15.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.

    Article  CAS  PubMed  Google Scholar 

  15. Fox J, Monette G. Generalized collinearity diagnostics. J Am Stat Assoc. 2012;87:178–83.

    Article  Google Scholar 

  16. Khera R, Angraal S, Couch T, Welsh JW, Nallamothu BK, Girotra S, et al. Adherence to methodological standards in research using the national inpatient sample. JAMA 2017;318:2011–18.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chrouser KL, Ajiboye OB, Oyetunji TA, Chang DC. Priapism in the United States: the changing role of sickle cell disease. Am J Surg. 2011;201:468–74.

    Article  PubMed  Google Scholar 

  18. Sui W, Onyeji IC, James MB, Stahl PJ, RoyChoudhury A, Anderson CB. Risk factors for priapism readmission. J Sex Med. 2016;13:1555–61.

    Article  PubMed  Google Scholar 

  19. Paro A, Hyer JM, Diaz A, Tsilimigras DI, & Pawlik TM Profiles in social vulnerability: the association of social determinants of health with postoperative surgical outcomes. Surgery. 2021;170:1777–84.

  20. Ballas SK, Lyon D. Safety and efficacy of blood exchange transfusion for priapism complicating sickle cell disease. J Clin Apheresis. 2016;31:5–10.

    Article  PubMed  Google Scholar 

  21. Joice GA, Kates M, Sopko NA, Hannan JL, Bivalacqua TJ. Sickle cell disease in priapism: disparity in care? Urology. 2015;86:72–9.

    Article  PubMed  Google Scholar 

  22. Johnson MJ, Hallerstrom M, Alnajjar HM, Johnson TF, Skrodzka M, Chiriaco G, et al. Which patients with ischaemic priapism require further investigation for malignancy? Int J Impot Res. 2020;32:195–200.

    Article  Google Scholar 

  23. Luca FD, Zacharakis E, Shabbir M, Maurizi A, Manzi E, Zanghi A, et al. Malignant priapism due to penile metastases: case series and literature review. Archivio Ital Di Urologia E Androl. 2015;88:150–2.

    Article  Google Scholar 

  24. Ralph O, Shroff N, Johnson MJ, Al-Najjar HM, Ralph D. Malignancy: a rare, important and poorly understood cause of priapism. Apr. 2021;9:312–9.

    Google Scholar 

  25. Lin YH, Kim JJ, Stein NB, Khera M. Malignant priapism secondary to metastatic prostate cancer: a case report and review of literature. Rev Urol. 2011;13:90–4.

    PubMed  PubMed Central  Google Scholar 

  26. Nichols NML, Yerneni K, Chiu AB, Lu AY, Tan LA. Priapism associated with lumbar stenosis: case report and literature review. J Spine Surg. 2019;5:596–600.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hirota K, Hanakita J, Takahashi T, Kanematsu R, Ueno M, Kasuya H, et al. Walking-evoked erection in patients with lumbar degenerative diseases: eight cases and review of the literature. Asian Spine J. 2021;15:172.

  28. Macfarlane R. Priapism in acute spinal cord injury. Spinal Cord. 2012;50:563–563.

    Article  CAS  PubMed  Google Scholar 

  29. Tausch TJ, Zhao LC, Morey AF, Siegel JA, Belsante MJ, Seideman CA, et al. Malleable penile prosthesis is a cost‐effective treatment for refractory ischemic priapism. J Sex Med. 2015;12:824–6.

    Article  PubMed  Google Scholar 

  30. Yücel ÖB, Pazır Y, Kadıoğlu A. Penile prosthesis implantation in priapism. Sex Med Rev 2018;6:310–18.

    Article  PubMed  Google Scholar 

  31. Mishra K, Loeb A, Bukavina L, Baumgarten A, Beilan J, Mendez M, et al. Management of priapism: a contemporary review. Sex Med Rev. 2020;8:131–9.

    Article  PubMed  Google Scholar 

  32. Zacharakis E, Garaffa G, Raheem AA, Christopher AN, Muneer A, Ralph DJ. Penile prosthesis insertion in patients with refractory ischaemic priapism: early vs delayed implantation. BJU Int. 2014;114:576–81.

    Article  PubMed  Google Scholar 

  33. Burns EM, Rigby E, Mamidanna R, Bottle A, Aylin P, Ziprin P, et al. Systematic review of discharge coding accuracy. J Public Health. 2012;34:138–48.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Columbia University Irving Medical Center,, New York, NY, USA

    Albert S. Ha, David S. Han, Brendan K. Wallace, Valary Raup, Gina M. Badalato & Joseph P. Alukal

  2. Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    Brendan K. Wallace, Gina M. Badalato & Joseph P. Alukal

  3. Department of Biostatistics, Columbia University Mailman School of Public Health,, New York, NY, USA

    Caleb Miles

  4. Department of Epidemiology, Columbia University Mailman School of Public Health,, New York, NY, USA

    Nahid Punjani

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  1. Albert S. Ha
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Contributions

Conceptualization: ASH, JPW. Data curation: ASH. Formal analysis: ASH, CM. Funding acquisition: N/A. Investigation: ASH, BKW, GMB, JPA. Methodology: ASH, CM. Software: ASH, CM. Supervision: GMB, JPA, NP, VR. Validation: ASH, BKW. Visualization: ASH. Writing – original draft preparation: ASH, DSH, BKW,. Writing – review and editing: ASH, DSH, BKW, JPA, GMB, NP, VR.

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Correspondence to Joseph P. Alukal.

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Ha, A.S., Han, D.S., Wallace, B.K. et al. A population-based analysis of predictors of penile surgical intervention among inpatients with acute priapism. Int J Impot Res 35, 107–113 (2023). https://doi.org/10.1038/s41443-021-00518-4

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  • DOI: https://doi.org/10.1038/s41443-021-00518-4

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