Pyrgidis Nikolaos, Schulz Gerald B, Chaloupka Michael, Volz Yannic, Pfitzinger Paulo L, Berg Elena, Weinhold Philipp, Jokisch Friedrich, Stief Christian G, Becker Armin J, Marcon Julian
Department of Urology, University Hospital, LMU, Munich, Germany.
Int J Impot Res. 2024 May 22. doi: 10.1038/s41443-024-00915-5.
We aimed to provide evidence on the trends and in-hospital outcomes of patients with low- and high-flow priapism through the largest study in the field. We used the GeRmAn Nationwide inpatient Data (GRAND), provided by the Research Data Center of the Federal Bureau of Statistics (2008-2021), and performed multiple patient-level analyses. We included 6,588 men with low-flow and 729 with high-flow priapism. Among patients with low-flow priapism, 156 (2.4%) suffered from sickle cell disease, and 1,477 (22.4%) patients required shunt surgery. Of them, only 37 (2.5%) received a concomitant penile prosthesis implantation (30 inflatable and 7 semi-rigid prosthesis). In Germany, the total number of patients with low-flow priapism requiring hospital stay has steadily increased, while the number of patients with high-flow priapism requiring hospital stay has decreased in the last years. Among patients with high-flow priapism, 136 (18.7%) required selective artery embolization. In men with low-flow priapism, sickle cell disease was associated with high rates of exchange transfusion (OR: 21, 95% CI: 14-31, p < 0.001). The length of hospital stay (p = 0.06) and the intensive care unit admissions (p = 0.9) did not differ between patients with low-flow priapism due to sickle cell disease versus other causes of low-flow priapism. Accordingly, in men with high-flow priapism, embolization was not associated with worse outcomes in terms of length of hospital stay (p > 0.9), transfusion (p = 0.8), and intensive care unit admission (p = 0.5). Low-flow priapism is an absolute emergency that requires shunt surgery in more than one-fifth of all patients requiring hospital stay. On the contrary, high-flow priapism is still managed, in most cases, conservatively.
我们旨在通过该领域规模最大的研究，提供有关低流量和高流量阴茎异常勃起患者的趋势及住院结局的证据。我们使用了由联邦统计局研究数据中心提供的德国全国住院患者数据（GRAND，2008 - 2021年），并进行了多项患者层面的分析。我们纳入了6588例低流量阴茎异常勃起男性患者和729例高流量阴茎异常勃起男性患者。在低流量阴茎异常勃起患者中，156例（2.4%）患有镰状细胞病，1477例（22.4%）患者需要进行分流手术。其中，只有37例（2.5%）同时接受了阴茎假体植入（30例植入可膨胀假体，7例植入半刚性假体）。在德国，需要住院治疗的低流量阴茎异常勃起患者总数稳步增加，而在过去几年中，需要住院治疗的高流量阴茎异常勃起患者数量有所下降。在高流量阴茎异常勃起患者中，136例（18.7%）需要进行选择性动脉栓塞。在低流量阴茎异常勃起男性患者中，镰状细胞病与高比例的换血治疗相关（比值比：21，95%置信区间：14 - 31，p < 0.001）。因镰状细胞病导致的低流量阴茎异常勃起患者与其他原因导致的低流量阴茎异常勃起患者在住院时间（p = 0.06）和重症监护病房收治率（p = 0.9）方面并无差异。因此，在高流量阴茎异常勃起男性患者中，就住院时间（p > 0.9）、输血（p = 0.8）和重症监护病房收治率（p = 0.5）而言，栓塞治疗与较差结局无关。低流量阴茎异常勃起是一种绝对紧急情况，超过五分之一需要住院治疗的患者需要进行分流手术。相反，在大多数情况下，高流量阴茎异常勃起仍采用保守治疗。
