The Hemodynamic Effects of Intracavernosal Phenylephrine for the Treatment of Ischemic Priapism

Abstract

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.

The 10-year priapism experience: identifying clearer targets for intervention

“…This highlights the importance of understanding regional differences in patient populations. For instance, in a recent study looking at the hemodynamic effects of phenylephrine in the treatment of ischemic priapism, a group identified drug induced priapism to be the leading cause of priapism, of which a majority of that was secondary to penile injection therapy (6). For our institution, erectogenic medications accounted for 24% of patients presenting with priapism, but sickle cell anemia accounted for the majority of the visits.…”

“…A large majority of visits were the result of recurrent ischemic priapism (93% of EM managed patients and 69% of the urology consults). Recurrent ischemic priapism is not unique in our patient population, as other patient level studies have shown up to 50% of the priapism patients having multiple visits for priapism (6,19). Recurrent ischemic priapism is described as painful and multiple transient episodes of priapism that can progress into an acute ischemic episode.…”

“…The 10-year priapism experience: identifying clearer targets for intervention that the healthcare consequences of priapism have received little awareness despite priapism being considered one of the worst complications of sickle cell disease (4). Some of the largest studies include 100-200 priapism patients that each illuminate an important clinical aspect of priapism (management, prevention, erectile dysfunction outcomes), however more studies are needed to be able to understand the heterogeneity of this patient population (6)(7)(8).…”

“…Among those patients, 10 (29%) had a prior shunt completed. Consults who were transferred had an average duration of priapism of median 26 hours (IQR, 10-48) compared to consults who were not transferred [median 5.5 hours (IQR, [4][5][6][7][8]]. The majority of patients (75%) requiring an OR procedure were transferred patients.…”