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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

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 availability

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.

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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 (2022). https://doi.org/10.1038/s41443-022-00592-2

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