Baker Ryan C, Bergeson Rachel L, Yi Yooni A, Ward Ellen E, Morey Allen F
Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Transl Androl Urol. 2020 Feb;9(1):87-92. doi: 10.21037/tau.2019.07.15.
The objective of this study is to review our 12-year experience with the 5-α reductase inhibitor dutasteride as a potential long-term treatment option for stuttering priapism. Dutasteride has a uniquely long half-life of 35 days which offers a theoretical advantage as a chronic therapy for management of stuttering priapism.
We retrospectively reviewed patients with stuttering priapism in our database from 2006-2018 treated with dutasteride. Men with concurrent use of medications other than dutasteride to treat stuttering priapism were excluded. Patients were started on a dose of 0.5 mg daily and tapered to a more infrequent dosing schedule, ranging from 0.5 mg every other day to once weekly. The frequency of priapism episodes before and after initiation of dutasteride therapy was analyzed.
Among 21 cases, 13 patients met our inclusion criteria (mean age 43 years). Median follow-up on daily dutasteride was 79 days, and median follow-up on tapered dutasteride was 607 days. A total of 11/13 (85%) men treated with dutasteride had some degree of improvement-5/13 (38%) had complete resolution of their symptoms and 6/13 (46%) had reduced frequency and/or severity of their episodes. Among 5/13 (38%) men who had >2 emergency room (ER) visits for ischemic priapism prior to therapy, most (3/5, 60%) did not require any ER visits while on dutasteride therapy. Among the five men who received chronic, tapered-dose therapy, all reported continued suppression of priapistic episodes. Among 4 patients with sickle cell disease (SCD), 3/4 (75%) ultimately chose more invasive therapy including androgen deprivation therapy (ADT) and penile prosthesis. Side effects were minimal and included gynecomastia (8%), decreased libido (8%), and fatigue (8%).
In patients with stuttering priapism, daily dutasteride therapy is a promising treatment option to reduce the frequency and severity of priapistic episodes without significant side effects. Therapy can effectively be tapered to once weekly dosing without a reduction in efficacy.
本研究的目的是回顾我们使用5-α还原酶抑制剂度他雄胺作为口吃性阴茎异常勃起潜在长期治疗方案的12年经验。度他雄胺具有独特的35天半衰期，这为口吃性阴茎异常勃起的慢性治疗提供了理论优势。
我们回顾性分析了2006年至2018年在我们数据库中接受度他雄胺治疗的口吃性阴茎异常勃起患者。排除同时使用度他雄胺以外的药物治疗口吃性阴茎异常勃起的男性。患者开始时每日服用0.5毫克，然后逐渐减少服药频率，范围从每隔一天0.5毫克到每周一次。分析了度他雄胺治疗开始前后阴茎异常勃起发作的频率。
在21例患者中，13例符合我们的纳入标准（平均年龄43岁）。度他雄胺每日治疗的中位随访时间为79天，逐渐减量治疗的中位随访时间为607天。接受度他雄胺治疗的13名男性中，共有11名（85%）有一定程度的改善，其中5名（38%）症状完全缓解，6名（46%）发作频率和/或严重程度降低。在治疗前因缺血性阴茎异常勃起而急诊室就诊超过2次的13名男性中的5名（38%）中，大多数（3/5，60%）在接受度他雄胺治疗期间无需再去急诊室就诊。在接受长期逐渐减量治疗的5名男性中，所有人都报告阴茎异常勃起发作持续得到抑制。在4例镰状细胞病（SCD）患者中，3/4（75%）最终选择了包括雄激素剥夺疗法（ADT）和阴茎假体植入在内的更具侵入性的治疗方法。副作用最小，包括乳腺增生（8%）、性欲减退（8%）和疲劳（8%）。
对于口吃性阴茎异常勃起患者，每日度他雄胺治疗是一种有前景的治疗选择，可减少阴茎异常勃起发作的频率和严重程度，且无明显副作用。治疗可有效减至每周一次给药，而不降低疗效。
