Department of Urology, Rush University Medical Center, Chicago, IL, USA.
J Sex Med. 2014 Jan;11(1):197-204. doi: 10.1111/jsm.12359. Epub 2013 Nov 27.
The management of recurrent ischemic priapism (RIP) is not clearly defined. Ketoconazole (KTZ) is used to treat RIP and produces a temporary hypogonadal state to suppress sleep-related erections (SREs), which often evolve into episodes of ischemic priapism in this population.
We review our experience to prevent RIP using KTZ and present our outcomes using a decreased dose regimen.
A retrospective chart review and phone survey of 17 patients with RIP was performed. KTZ inhibits adrenal and gonadal testosterone production with a half-life of 8 hours. By suppressing testosterone levels, SREs are interrupted. We compared our previous protocol of three times daily (TID) KTZ dosing with prednisone for 6 months with our current regimen of initiating KTZ 200 mg TID with prednisone 5 mg daily for 2 weeks and then tapering to KTZ 200 mg nightly for 6 months.
The primary outcome was the prevention of RIP using KTZ. Secondary outcomes included side effects secondary to KTZ use and patient satisfaction.
All men experienced daily or almost daily episodes of prolonged, painful erections prior to starting KTZ. The mean number of emergency room (ER) visits per patient prior to starting KTZ was 6.5. No patient required an ER visit for RIP while on KTZ. Sixteen of 17 patients (94%) had complete resolution of priapism while on KTZ with effects noted immediately after starting therapy and no reported sexual side effects attributed to KTZ. One man stopped therapy after 4 days because of nausea/vomiting. Fourteen of 16 men eventually discontinued KTZ after a median duration of 7 months. Twenty-nine percent reported no recurrent priapic episodes after discontinuing. A total of 78.6% had partial or complete resolution of symptoms persisting after KTZ was discontinued with a mean post-treatment follow-up of 36.7 months.
No reliable effective preventative therapy has been identified for RIP. In our relatively sizable single-center experience, KTZ appears to be a reasonably effective, safe, and inexpensive treatment to prevent RIP while preserving sexual function. We now recommend our tapered dose regimen listed above. After 6 months, we recommend stopping the medication as we have found a majority of patients will not need to resume nightly KTZ.
复发性缺血性阴茎异常勃起（RIP）的治疗方法尚未明确。酮康唑（KTZ）用于治疗 RIP，并产生暂时的性腺功能减退状态，以抑制睡眠相关勃起（SRE），而 SRE 常在此类人群中发展为缺血性阴茎异常勃起。
我们回顾使用 KTZ 预防 RIP 的经验，并展示使用降低剂量方案的结果。
对 17 例 RIP 患者进行回顾性图表分析和电话调查。KTZ 通过抑制肾上腺和性腺的睾酮产生，半衰期为 8 小时。通过抑制睾酮水平，中断 SRE。我们比较了以前的方案，即每日三次（TID）KTZ 联合泼尼松治疗 6 个月，与目前的方案，即开始 KTZ 200mg TID 联合泼尼松 5mg 每日一次治疗 2 周，然后逐渐减量至 KTZ 200mg 每晚一次治疗 6 个月。
使用 KTZ 预防 RIP 的主要结果。次要结果包括 KTZ 使用的副作用和患者满意度。
所有男性在开始使用 KTZ 之前均经历过每日或几乎每日的长时间、疼痛性勃起。在开始 KTZ 之前，每位患者平均急诊就诊次数为 6.5 次。在使用 KTZ 期间，无患者因 RIP 而需要急诊就诊。17 例患者中有 16 例（94%）在使用 KTZ 时完全缓解了阴茎异常勃起，在开始治疗后立即出现效果，且无报告归因于 KTZ 的性副作用。1 例男性因恶心/呕吐而在 4 天后停止治疗。16 例男性中有 14 例在中位时间 7 个月后最终停用 KTZ。29%的患者在停用 KTZ 后无复发性阴茎异常勃起发作。在停用 KTZ 后，78.6%的患者症状部分或完全缓解，平均随访时间为 36.7 个月。
目前尚未发现针对 RIP 的可靠有效预防疗法。在我们相对较大的单中心经验中，KTZ 似乎是一种合理有效的、安全的、廉价的治疗方法，可预防 RIP，同时保留性功能。我们现在推荐上述剂量逐渐减少的方案。6 个月后，我们建议停止用药，因为我们发现大多数患者不再需要每晚服用 KTZ。
