The Ohio State University Department of Urology, Columbus, Oho, USA.
The Ohio State University Department of Urology, Columbus, Oho, USA.
Sex Med Rev. 2020 Jan;8(1):140-149. doi: 10.1016/j.sxmr.2019.03.004. Epub 2019 Apr 12.
Non-ischemic or high-flow priapism is derived from unregulated arterial inflow within the penis, which is significantly less common and, therefore, less well characterized than ischemic or low-flow priapism.
We collected the most recent available data and summarized the findings.
All literature related to non-ischemic priapism from 2000-2018 from several databases was reviewed, and 105 articles, including any relevant referenced articles, were ultimately included.
We evaluated modality success rates, need for repeat procedures, and effects on erectile function.
237 cases of non-ischemic priapism were evaluated. Approximately 27% of patients underwent observation or medical management as the first treatment modality, whereas 73% underwent intervention without observation or medical management beforehand. Angiographic embolization with temporary agents was the most common intervention and generally resulted in both moderate resolution of non-ischemic priapism and moderate preservation of baseline erectile function. Patients who underwent embolization with permanent agents experienced higher rates of resolution, as well as lower rates of erectile dysfunction (ED).
Most of the literature is in the form of case reports and small case series, thus limiting the quality and quantity of evidence available to draw decisive conclusions. However, from the available data, it is reasonable to presume that patients can undergo a trial of conservative management, then pursue embolization first with temporary agents. The analysis of the data demonstrated ED rates were higher with temporary agents than permanent agents. The literature quotes ED rates as low as 5% when using temporary agents and 39% with permanent agents. Our results were, in fact, the opposite, with higher ED rates when using temporary agents vs permanent (17-33% vs 8-17%). Further studies are required to better characterize the success and outcomes of angioembolization. Ingram AR, Stillings SA, Jenkins LC. An Update on Non-Ischemic Priapism. Sex Med Rev 2020;8:140-149.
非缺血性或高流量性阴茎异常勃起源于阴茎内不受调节的动脉流入，其明显比缺血性或低流量性阴茎异常勃起少见，因此特征描述也较少。
我们收集了最新的可用数据并进行了总结。
从多个数据库中检索了 2000 年至 2018 年与非缺血性异常勃起相关的所有文献，并最终纳入了 105 篇文章，包括任何相关的参考文献。
我们评估了治疗方式的成功率、是否需要重复治疗，以及对勃起功能的影响。
共评估了 237 例非缺血性阴茎异常勃起患者。约 27%的患者接受了观察或药物治疗作为初始治疗方法，而 73%的患者在接受观察或药物治疗之前接受了介入治疗。带临时试剂的血管造影栓塞是最常见的介入治疗方法，通常可以使非缺血性阴茎异常勃起中度缓解，并且对基线勃起功能中度保留。接受永久性试剂栓塞的患者的缓解率更高，勃起功能障碍（ED）的发生率更低。
大多数文献都是病例报告和小病例系列，因此限制了得出明确结论的可用证据的质量和数量。然而，从现有的数据来看，可以合理地假设患者可以先尝试保守治疗，然后再先用临时试剂进行栓塞。对数据的分析表明，使用临时试剂的 ED 发生率高于使用永久性试剂，使用临时试剂的 ED 发生率为 5%，而使用永久性试剂的 ED 发生率为 39%。实际上，我们的结果相反，使用临时试剂比使用永久性试剂的 ED 发生率更高（17%-33%比 8%-17%）。需要进一步的研究来更好地描述血管栓塞的成功率和结果。Ingram AR, Stillings SA, Jenkins LC. 非缺血性阴茎异常勃起的最新进展。性医学评论 2020;8:140-149.
