Penile Prosthesis Placement during Admission for Ischemic Priapism
Jane Renee Kielhofner, BS, Brittany D. Berk, M.D., John Ernandez, B.A., Alexandra J. Berger Eberhardt, M.D., Steven L. Chang, M.D., Martin N. Kathrins, M.D..
Brigham and Women's Hospital, Boston, MA, USA.
Penile Prosthesis Placement during Admission for Ischemic Priapism
Introduction:Penile prosthesis placement (PPP) is utilized as surgical therapy for patients with erectile dysfunction secondary to prolonged ischemic priapism (IP). However, PPP may also be used for immediate treatment of refractory IP to prevent progressive fibrosis of corpora cavernosa and penile shortening/narrowing. AUA/SMSNA guidelines for diagnosis and management of priapism recommend consideration of PPP in patients with IP lasting >36 hours or refractory to shunting with or without tunneling. There is a need to understand long term outcomes of immediate PPP and patient factors associated with immediate PPP for IP.
Materials & Methods:We retrospectively gathered electronic billing record data from Premier database, a large, U.S. hospital-based, service-level, all-payer database. Utilizing ICD-10 codes specific to priapism and CPT codes specific to penile prosthesis, we identified 3,655 unique individuals who were admitted with a diagnosis of priapism from the last quarter of 2015 to 2020. Within this group, we collected demographic data, Charlson comorbidity status, number of presentations to care for IP, and assessed for predictors of prosthesis placement. Lastly, we evaluated the proportion of patients who had minor or major complications, and the nature of those complications.
Results:Of 3,655 patients diagnosed with priapism in the 5-year study period, 976 patients had multiple presentations for priapism, while 2,679 presented only once. Of this patient population, 58 patients underwent immediate penile prosthesis placement during admission. These 58 patients were matched with 147 patients seen for IP in the same hospitals who did not undergo PPP. Multivariate analysis showed predictors of prostheses placement were multiple prior episodes of priapism (OR 4.12, p=<0.0001) and presentation to a non-teaching hospital (OR 2.35, p=0.012). A non-statistically-significant trend was observed in Medicaid insured patients (compared to Medicare patients, OR 0.43, p=0.069). 55.18% (15/58) of these patients experienced minor complications, while 18.97% (11/58) of these patients experienced major complications.
Conclusions:Patients undergoing immediate PPP for IP are more likely to have had previous hospital encounters for IP. Complications from immediate PPP are high. Further research is needed to examine outcomes in immediate vs delayed PPP for IP.
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