Abern Michael R, Levine Laurence A
Rush University Medical Center, Chicago, Illinois 60612, USA.
J Urol. 2009 Oct;182(4):1401-6. doi: 10.1016/j.juro.2009.06.040. Epub 2009 Aug 15.
To our knowledge no standard therapy exists for the prevention of recurrent ischemic priapism. We used ketoconazole and prednisone with dosing titrated according to serum testosterone levels to suppress sleep related erections in an attempt to prevent recurrent episodes.
Eight patients with recurrent ischemic priapism were treated with ketoconazole and prednisone. Two patients had sickle cell anemia and 6 had idiopathic recurrent ischemic priapism. Testosterone was measured on initial presentation, and ketoconazole and prednisone dosing was titrated to approximately 200 ng/dl testosterone and based on the presence or absence of recurrent ischemic priapism episodes. The International Index of Erectile Function-5 questionnaire was administered to evaluate for erectile dysfunction. Patients were seen monthly and therapy was withdrawn after 6 months.
Mean testosterone before and after treatment was 468 and 275 ng/dl, respectively. Mean followup was approximately 1.5 years. One patient had 2 recurrent ischemic priapism episodes while on ketoconazole and prednisone treatment. Another patient experienced an increase in testosterone from 361 to 432 ng/dl after initiation of therapy, and 3 recurrent ischemic priapism episodes requiring emergency corporal irrigation. After dose titration testosterone was 184 ng/dl and the patient has had no subsequent episodes. Mean International Index of Erectile Function-5 score was 24.8 points. There were no recurrent ischemic priapism episodes after withdrawal of ketoconazole and prednisone, and no reported symptoms of hypogonadism.
Ketoconazole and prednisone therapy was well tolerated in these 8 patients with recurrent ischemic priapism, and with testosterone monitoring and dose titration it was successful in preventing recurrent episodes while preserving sexual function.
据我们所知，目前尚无预防复发性缺血性阴茎异常勃起的标准疗法。我们使用酮康唑和泼尼松，并根据血清睾酮水平调整剂量，以抑制与睡眠相关的勃起，试图预防复发。
8例复发性缺血性阴茎异常勃起患者接受酮康唑和泼尼松治疗。2例患有镰状细胞贫血，6例患有特发性复发性缺血性阴茎异常勃起。在初次就诊时测量睾酮水平，根据是否出现复发性缺血性阴茎异常勃起发作，将酮康唑和泼尼松的剂量调整至睾酮水平约为200 ng/dl。采用国际勃起功能指数-5问卷评估勃起功能障碍。患者每月复诊一次，6个月后停药。
治疗前后平均睾酮水平分别为468 ng/dl和275 ng/dl。平均随访时间约为1.5年。1例患者在接受酮康唑和泼尼松治疗期间出现2次复发性缺血性阴茎异常勃起发作。另1例患者在开始治疗后睾酮水平从361 ng/dl升至432 ng/dl，并出现3次复发性缺血性阴茎异常勃起发作，需要紧急阴茎海绵体冲洗。剂量调整后，睾酮水平为184 ng/dl，该患者此后未再发作。国际勃起功能指数-5平均评分为24.8分。停用酮康唑和泼尼松后未出现复发性缺血性阴茎异常勃起发作，也未报告性腺功能减退症状。
酮康唑和泼尼松治疗在这8例复发性缺血性阴茎异常勃起患者中耐受性良好，通过监测睾酮水平并调整剂量，成功预防了复发，同时保留了性功能。
