Hou Laurence T, Burnett Arthur L
Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Urol. 2021 Feb;205(2):545-553. doi: 10.1097/JU.0000000000001365. Epub 2020 Sep 11.
We evaluated the real-world effectiveness of regimented phosphodiesterase type 5 inhibitor dosing on recurrent ischemic priapism outcomes using emergency department visits as a proxy for therapeutic control of the disorder.
We performed a retrospective chart review of patients with recurrent ischemic priapism who were started on regimented phosphodiesterase type 5 inhibitor therapy from May 2006 to January 2020. We compared the number of emergency department visits per month during a 6-month period before treatment, during treatment and after treatment discontinuation. We extracted and categorized priapism outcomes such as priapism frequency and duration.
Of 216 patients identified with all cause priapism 114 were diagnosed with recurrent ischemic priapism and 42 were initiated on regimented phosphodiesterase type 5 inhibitor therapy. Treatment effectiveness was analyzed for 24 evaluable patients. Priapism etiology was idiopathic in 12 patients (50%), sickle cell disease in 11 (46%) and drug-induced in 1 (4%). The median length of regimented phosphodiesterase type 5 inhibitor use was 3 months (IQR 2-7). Treatment decreased emergency department visits per month by 4.4-fold (p <0.001), priapism duration tiers (p <0.001) and priapism frequency tiers (p <0.001). Of 24 patients 22 (92%) reported improvement in priapism outcomes, 9 of whom reported resolution of recurrent ischemic priapism episodes. A subgroup analysis of 17 patients with recurrent ischemic priapism relapse after treatment discontinuation showed a significant increase in priapism duration (p <0.001) and frequency (p <0.001) but no significant change in emergency department visits per month (p=0.91).
Regimented phosphodiesterase type 5 inhibitor therapy was an impactful treatment in managing recurrent ischemic priapism according to objective and subjective parameters. This study provides further support for the use of regimented phosphodiesterase type 5 inhibitor dosing as a preventive strategy for recurrent ischemic priapism.
我们以急诊就诊作为该疾病治疗控制的替代指标，评估了规律使用5型磷酸二酯酶抑制剂对复发性缺血性阴茎异常勃起结局的实际疗效。
我们对2006年5月至2020年1月开始接受规律5型磷酸二酯酶抑制剂治疗的复发性缺血性阴茎异常勃起患者进行了回顾性病历审查。我们比较了治疗前、治疗期间和治疗停药后6个月内每月的急诊就诊次数。我们提取并分类了阴茎异常勃起的结局，如阴茎异常勃起的频率和持续时间。
在216例因各种原因出现阴茎异常勃起的患者中，114例被诊断为复发性缺血性阴茎异常勃起，42例开始接受规律5型磷酸二酯酶抑制剂治疗。对24例可评估患者的治疗效果进行了分析。阴茎异常勃起的病因在12例患者中为特发性（50%），11例为镰状细胞病（46%），1例为药物性（4%）。规律使用5型磷酸二酯酶抑制剂的中位时长为3个月（四分位间距2 - 7）。治疗使每月急诊就诊次数减少了4.4倍（p<0.001），阴茎异常勃起持续时间分级（p<0.001）和阴茎异常勃起频率分级（p<0.001）。在24例患者中，22例（92%）报告阴茎异常勃起结局有所改善，其中9例报告复发性缺血性阴茎异常勃起发作得到缓解。对17例治疗停药后复发性缺血性阴茎异常勃起复发的患者进行亚组分析显示，阴茎异常勃起持续时间（p<0.001）和频率（p<0.001）显著增加，但每月急诊就诊次数无显著变化（p = 0.91）。
根据客观和主观参数，规律使用5型磷酸二酯酶抑制剂治疗在管理复发性缺血性阴茎异常勃起方面是一种有效的治疗方法。本研究为使用规律5型磷酸二酯酶抑制剂给药作为复发性缺血性阴茎异常勃起的预防策略提供了进一步支持。
