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Priapism Increases the Risk of Cardiovascular and Cerebrovascular Disease in Men
abstract
This abstract is available on the publisher's site.
Access this abstract nowPURPOSE
Priapism is a debilitating condition that affects sexual function. As a majority of cases are idiopathic, investigators have hypothesized underlying vascular dysfunction which may predispose men to priapism. We sought to determine if men are at risk for other sequelae of vascular dysfunction such as cardiovascular and thromboembolic disease after a priapism event.
MATERIALS AND METHODS
Using a large commercial insurance claims data warehouse, we evaluated all men (age ≥20) with a diagnosis of priapism from 2003-2020 and matched them to a cohort of men with other urological disorders of sexual dysfunction (erectile dysfunction, Peyronie's disease, and premature ejaculation). We identified incident disease (cardiovascular disease, heart disease, embolism, thrombosis, cerebrovascular disease) for all cohorts.
RESULTS
A total of 10,459 men with priapism were identified and were matched to men with erectile dysfunction, Peyronie's disease, or premature ejaculation. The mean age was 51.1 years old. Men with priapism showed increased incidence of heart disease, both ischemic (HR 1.24, 95% CI 1.09-1.42) and other heart disease (HR 1.24, 95% CI 1.12-1.38) in the years following the priapism diagnosis. Incident cerebrovascular disease was also more likely in men with a history of priapism (HR 1.33, 95% CI 1.15-1.55). Men requiring treatment for ischemic priapism had a higher hazard of cardiovascular and cerebrovascular disease. In addition, men with more priapism episodes had a higher rate of cardiovascular disease and thromboembolic events.
CONCLUSIONS
Men with priapism are at increased risk for cardiovascular and cerebrovascular events in the years following a priapism.
Additional Info
Disclosure statements are available on the authors' profiles:
The Risk of Cardiovascular and Cerebrovascular Disease in Men With a History of Priapism
J Urol 2022 Sep 09;[EPub Ahead of Print], E Mulloy, S Li, F Belladelli, F Del Giudice, F Glover, ML EisenbergFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The article by Mulloy et al in J Urology raises additional considerations for the management of men with priapism. The authors evaluated over 10,000 men using an administrative database, comparing the risk of developing subsequent cardiovascular, cerebrovascular and thromboembolic disease men with a history of priapism. The men with priapism had a 24% higher risk (OR, 1.24) of subsequent disease relative to men with a history of erectile dysfunction, Peyronie's disease or premature ejaculation. This means that even men who are already at risk for cardiovascular disease (men with ED) have a lower risk of subsequent vascular disease than men with priapism. The authors appropriately removed men with a diagnosis of sickle cell disease from the priapism patients, emphasizing the relevance of these observations for men with idiopathic priapism. The study has the usual limitations: The data are based on coding with ICD-10 and CPT codes, and the database is almost exclusively based on patients who have commercial insurance.
Taken together, the observed increased risk of cardiovascular disease for men with priapism has important clinical implications. This is not easy for the urologist caring for men with priapism. Not only do you have to be circumspect with patients regarding the risk of subsequent erectile dysfunction, especially with longer duration of priapism, but these data now suggest that we should counsel men about the increased incident risk of cardiovascular disease. Such concern could appropriately lead to cardiology or other focused referral after treatment for priapism.