Yarak Naim, El Khoury Joey, Coloby Patrick, Bart Stéphane, Abdessater Maher
NOVO Hospital, Paris, Pontoise, France.
Basic Clin Androl. 2024 Dec 4;34(1):21. doi: 10.1186/s12610-024-00237-y.
Stuttering priapism is characterized by recurrent, self-limited episodes of penile erection lasting from a few minutes to a maximum of three hours, often resolving spontaneously. These episodes can occur with or without sexual stimulation. If not treated promptly and effectively, stuttering priapism can severely impact a patient's quality of life, leading to significant psychological distress and anxiety related to sexual performance. Although it has been associated with various hematological disorders and pharmacological treatments, many cases of stuttering priapism remain idiopathic, meaning they have no identifiable cause. Currently, no conclusive randomized clinical trials exist on the management of idiopathic stuttering priapism. This study aims to review the existing literature on the pathophysiology and management of idiopathic stuttering priapism and propose an algorithm to assist physicians in its evaluation and treatment.
A systematic literature review was conducted using the PubMed database, focusing on the terms "idiopathic," "stuttering," "ischemic," and "priapism." The search identified 23 relevant references published between 1991 and 2022. The selection and analysis of these studies adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and results were described qualitatively. Recent research into the effectiveness, sustainability, tolerability, and side effects of various treatments for idiopathic stuttering priapism has enhanced the understanding of its underlying molecular mechanisms. Various treatments, targeting different mechanisms, have been identified that can potentially reduce the frequency and severity of episodes and improve patient outcomes.
Current research predominantly addresses the acute treatment of idiopathic stuttering priapism rather than strategies to alter the disease's overall course. The limited number of treatment reviews, case reports, and the low level of evidence available, combined with the absence of randomized clinical trials, prevent the establishment of a consensus on treatment protocols. As a result, idiopathic stuttering priapism remains under-recognized and under-treated. This review proposes a management framework to help clinicians access and apply the available literature effectively, minimizing the reliance on extensive case reports and review articles.
间歇性阴茎异常勃起的特征是阴茎反复出现自限性勃起，持续数分钟至最长三小时，通常可自行缓解。这些发作可在有或没有性刺激的情况下发生。如果不及时有效治疗，间歇性阴茎异常勃起会严重影响患者的生活质量，导致与性功能相关的显著心理困扰和焦虑。虽然它与各种血液系统疾病和药物治疗有关，但许多间歇性阴茎异常勃起病例仍为特发性，即没有可识别的病因。目前，关于特发性间歇性阴茎异常勃起的治疗尚无结论性的随机临床试验。本研究旨在回顾关于特发性间歇性阴茎异常勃起的病理生理学和治疗的现有文献，并提出一种算法以协助医生进行评估和治疗。
使用PubMed数据库进行了系统的文献综述，重点关注“特发性”“间歇性”“缺血性”和“阴茎异常勃起”等术语。检索确定了1991年至2022年间发表的23篇相关参考文献。这些研究的选择和分析遵循PRISMA（系统评价和Meta分析的首选报告项目）指南，并对结果进行了定性描述。最近对特发性间歇性阴茎异常勃起的各种治疗方法的有效性、可持续性、耐受性和副作用的研究增进了对其潜在分子机制的理解。已确定了针对不同机制的各种治疗方法，这些方法可能会降低发作的频率和严重程度，并改善患者的预后。
目前的研究主要关注特发性间歇性阴茎异常勃起的急性治疗，而非改变疾病整体病程的策略。治疗综述、病例报告数量有限，证据水平较低，再加上缺乏随机临床试验，使得无法就治疗方案达成共识。因此，特发性间歇性阴茎异常勃起仍然未得到充分认识和治疗。本综述提出了一个管理框架，以帮助临床医生有效获取和应用现有文献，尽量减少对大量病例报告和综述文章的依赖。
