Presentation Authors: Marc Nelson, Eric Kirshenbaum, Jazzmyne Montgomery, Michael Felice, Petar Bajic*, Emanuel Eguia, Patrick Sweigert, Marshall Baker, Gopal Gupta, Kevin McVary, Ahmer Farooq, Maywood, IL
Introduction: Priapism is a urological emergency in which there is persistent penile erection unrelated to, or following, sexual stimulation. Studying this subject has been difficult due to the variability in presentation. The US incidence of priapism is estimated to be 8.05 per 100,000 emergency room visits, or roughly 10,000 per year. This data is born out of the nationwide samples, which does not allow one to follow a patient longitudinally over time. The risk factors that would predispose one to recurrent priapism are not well established.
Methods: The Healthcare Cost and Utilization Project State Emergency Department Database, State Inpatient Database, and State Ambulatory Surgery Database for Florida from 2009 to 2014 and California from 2007 to 2011 was used. Patients were identified as having a diagnosis of priapism by ICD-9 code (607.3) and relevant patient demographics, encounter, and hospital information were extracted. Unique patient linkage variables were used to track patient encounters across time and facilities. Recurrent priapism was defined as four or greater priapism encounters. Univariate analysis was performed using Student's t-test, Pearson chi-square test, and Kruskal-Wallis H test. A multivariable logistic regression model was used to determine predictors of recurrent priapism encounters.
Results: 5872 patients had a hospital encounter for priapism within the study period and locations. Of these patients, 4217 had a single encounter, 1208 had two or three priapism encounters, and 447 had four or greater. Patients with recurrent priapism had an average of 7.82 encounters. (Table 1) On multivariate analysis, factors increasing the odds of recurrent visits included Black race (OR 1.83, p < 0.005), Hispanic race (OR 1.49, p < 0.005), Asian race (OR 2.79, p < 0.005), non-private insurance (e.g. Medicaid 1.63, p < 0.005), and sickle-cell anemia (OR 5.08, p < 0.005). Factors decreasing odds of recurrent visits included age>45 (OR 0.52, p < 0.005), spinal cord injury (OR 0.05, p < 0.005) and diagnosis of erectile dysfunction (OR 0.34, p < 0.005).
Conclusions: It appears that approximately 7.6% of priapism patients will go on to have recurrent priapism. There are several demographic and medical risk factors that should be considered when treating and counseling patients. Further longitudinal studies should be aimed at confirming these risk factors and ways in prevention.