Presentation Authors: Hanson Zhao*, Carl Berdahl, Ariel Moradzadeh, Justin Houman, Howard Kim, Karyn Eilber, Joshua Pevnick, Jennifer Anger, Los Angeles, CA
Introduction: Priapism is a known risk of intracavernosal injections (ICIs) of erectile agents. Recreational use of ICIs is a high-risk behavior that involves sharing of these agents by men without physician regulation. We characterize the etiologies and outcomes of priapism at a Los Angeles metropolitan medical center to better understand patterns of usage of recreational ICIs and the public health implications.
Methods: With IRB approval, we performed a retrospective review of all men who presented with priapism to the emergency room of a Los Angeles tertiary medical center from 2010 to 2018. We extracted and analyzed information including patient demographics, priapism etiology, and treatments. We compared outcomes between patients who presented with priapism after recreational ICI and patients who presented with other etiologies of priapism.
Results: 169 priapism encounters by 143 unique patients were identified. Recreational ICI accounted for 82/169 (49%) priapism encounters. Other etiologies include: urologist-prescribed ICI (25%), oral PDE5 inhibitor (5%), sickle cell (4%), trazadone (5%), other medication (5%), and unknown (7%). The proportion of priapism visits caused by recreational ICI increased over the study period from 38% in the first three years to 62% in the last three years (p=0.02). Seven patients (9%) in the recreational ICI group also admitted to concurrent methamphetamine or cocaine use. 43 (30%) of all patients were known to be HIV+, 84% of whom (36/43) presented after use of recreational ICI. Patients who used recreational injections were younger than those who presented with other etiologies, (43.5 vs 47.5 years, p=0.048) and had a delayed presentation (median 12 vs. 8 hours, p=0.0001). There was no statistical difference in the proportion of patients who required an operative intervention in each group (14.6% of recreational ICI users vs. 16.1% of all other patients p=0.23).
Conclusions: An increasingly large proportion of priapism visits are attributed to recreational use of intracavernosal injections at our institution. To our knowledge, this is the largest series of priapism cases described to date. While the short-term treatment outcomes appear similar, this is a unique and high-risk patient population that may not be aware of the risk of priapism from ICIs given that many of these men were not prescribed the intracavernosal agents and adequately warned of priapism by a physician. Efforts should be made to increase public awareness of the risks of both priapism and possibly unsafe needle usage in this population.
Source of Funding: This research was supported by NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881