Aim We sought to evaluate whether the administration of phenylephrine (PE) at concentrations higher than those described in guidelines resulted in any significant changes in vital signs or impacted outcomes. Methods After receiving institutional review board approval, we retrospectively reviewed the charts of patients presenting to our emergency department between May 1, 2014, and August 15, 2016, using International Classification of Diseases, Ninth Edition and Internation Classification of Disease, Tenth Edition diagnosis codes for priapism. Treatment was reviewed, including corporal aspiration/irrigation, injection of PE, and shunt procedures. Vital signs were compared before and after treatment with PE. Baseline variables were explored with categorical data analysis (chi-squared tests, t-tests, and Mann-Whitney nonparametric tests). Where feasible, linear regression was used to evaluate outcomes. Main Outcome Measure Detumescence and changes in blood pressure and heart rate. Results We identified 74 different patient encounters of acute priapism. The median age was 36.5 years (interquartile range [IQR] = 27–47), and the median time to presentation was 5.4 hours (IQR = 4.0–9.6). 62 percent of cases were due to drug-induced priapism. In 58 (74%) encounters, patients received PE. The median dose of PE given was 1000 μg (IQR 500–2,000). Univariate regression found no association between PE dose and change in patient heart rate or blood pressure. A statistically significant decrease in heart rate (HR) (−4.2 BPM), systolic blood pressure (BP) (−1.8 mm Hg), and diastolic BP (−5.4 mm Hg) was noted. Fifty-three of 58 (91%) patients receiving PE experienced detumescence at the bedside, 2 required shunting in operating room, and 3 refused treatment and left against medical advice. No adverse events occurred. Conclusion We frequently treat patients with high doses of PE and seldom notice adverse effects, typically resulting in resolution of priapism without any additional procedures. Careful administration of high doses of intracavernosal PE in patients presenting with priapism does not appear to significantly affect heart rate or blood pressure and may help prevent further ischemic damage and achieve detumescence effectively and efficiently.
119 Background: Prostate cancer is the third most common cancer among men. PSA based screening for prostate cancer was introduced in the 1980s and resulted in a significant decline in prostate cancer mortality. Current AUA guidelines recommend PSA screening in average risk patients between the ages of 55 and 69. There are public health concerns in rural areas of the United States (US) potentially due to decreased access of care. In this study, we sought to evaluate the prevalence of prostate cancer screening and death rate in rural communities within the US. Methods: After IRB approval, data was collected from several different sources. Annual prostate cancer death rate (2011-2015) was obtained from the American Cancer Society. Data from the Behavioral Risk Factor Surveillance System regarding prostate cancer screening during this time interval was acquired. Data regarding populations was obtained from the US Census. Descriptive analyses were used to describe the population and Pearson Correlation Coefficient to determine screened, death rates and rurality correlations. All analyses were completed using SPSS. Results: The median percent of US population residing in rural and urban areas was 25.8% (IQR 22.1%) and 73.8% (IQR 22.1%), respectively. The median percent of male patients screened using PSA 50 years and older was 56.2% (IQR 7.0%). The median death rate (per 100,000) from prostate cancer per state was 19.5 (IQR 1.7%). Prostate cancer death rate was found to have no correlation to percent of population screened (p = 0.29) and percent rurality (p = 0.98). The percent rural population versus percent of screened men over the age of 50 was also not significant (p = 0.20). Conclusions: Neither death rate nor screening rate for prostate cancer using PSA demonstrated a significant association with the percent of patient’s living in rural communities. This is evidence that within the US, rural communities are following guidelines for PSA screening for prostate cancer and therefore there is no discrepancy in prostate cancer death in these areas compared to urban. This study is evidence that the barriers that may be associated with living in rural communities, such as decreased access to healthcare do not translate into worse outcomes related to prostate cancer.
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