The Risk of Cardiovascular and Cerebrovascular Disease in Men With a History of Priapism

No AccessJournal of UrologyAdult Urology1 Jan 2023The Risk of Cardiovascular and Cerebrovascular Disease in Men With a History of PriapismThis article is commented on by the following:Editorial Comment Evan Mulloy, Shufeng Li, Federico Belladelli, Francesco Del Giudice, Frank Glover, and Michael L. Eisenberg Evan MulloyEvan Mulloy Department of Urology, Stanford University School of Medicine, Palo Alto, California , Shufeng LiShufeng Li Department of Urology, Stanford University School of Medicine, Palo Alto, California Department of Dermatology, Stanford University School of Medicine, Palo Alto, California , Federico BelladelliFederico Belladelli Department of Urology, Stanford University School of Medicine, Palo Alto, California Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy , Francesco Del GiudiceFrancesco Del Giudice Department of Urology, Stanford University School of Medicine, Palo Alto, California Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Rome, Italy , Frank GloverFrank Glover Emory University School of Medicine, Atlanta, Georgia , and Michael L. EisenbergMichael L. Eisenberg *Correspondence: Stanford University Department of Urology Center for Academic Medicine, 453 Quarry Road, Urology 5656, Palo Alto, California 93404 telephone: 650-725-5746; E-mail Address: [email protected] Department of Urology, Stanford University School of Medicine, Palo Alto, California View All Author Informationhttps://doi.org/10.1097/JU.0000000000002962AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: 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. References 1. . The incidence and management of priapism in Western Australia: a 16 year audit. Int J Impot Res. 2003; 15(4):272-276. Google Scholar 2. . Incidence of priapism in emergency departments in the United States. J Urol. 2013; 190(4):1275-1280. Link, Google Scholar 3. . Incidence of priapism in the general population. Urology. 2001; 57(5):970-972. Google Scholar 4. Priapism in patients with hemolytic disorders: a nationwide retrospective cohort study. Ann Hematol. 2021; 100(8):1947-1951. Google Scholar 5. . Priapism: a three-phase concept of management according to aetiology and prognosis. Br J Urol. 1986; 58(2):113-118. Google Scholar 6. . Erectile dysfunction after sickle cell disease-associated recurrent ischemic priapism: profile and risk factors. J Sex Med. 2015; 12(3):713-719. Google Scholar 7. . Low-flow priapism: risk factors for erectile dysfunction. BJU Int. 2002; 89(3):285-290. Google Scholar 8. . External validation of the priapism impact profile in a Jamaican cohort of patients with sickle cell disease. PLoS One. 2021; 16(10):e0258560. Google Scholar 9. . Outcome and erectile function following treatment of priapism: an institutional experience. Urol Ann. 2016; 8(1):46-50. Google Scholar 10. . Priapism in patients with chronic myeloid leukemia (CML): a systematic review. Acta Biomed. 2021; 92(3):e2021193. Google Scholar 11. . Malignancy: a rare, important and poorly understood cause of priapism. Sex Med Rev. 2021; 9(2):312-319. Google Scholar 12. . Priapism in hematological and coagulative disorders: an update. Nat Rev Urol. 2011; 8(4):223-230. Google Scholar 13. . Heparin-induced priapism. Int J Impot Res. 2001; 13(6):357-359. Google Scholar 14. . Factors predisposing to priapism in haemodialysis patients. Proc Eur Dial Transpl Assoc. 1976; 12:380-386. Google Scholar 15. . Should perioperative anticoagulation be an integral part of the priapism shunting procedure?Transl Androl Urol. 2013; 2(4):316-320. Google Scholar 16. . Acute ischemic priapism: an AUA/SMSNA guideline. J Urol. 2021; 206(5):1114-1121. Link, Google Scholar 17. . The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract. 2007; 61(12):2019-2025. Google Scholar 18. . Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003; 44(3):360-364. Crossref, Medline, Google Scholar 19. . Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005; 294(23):2996-3002. Google Scholar 20. . Erectile dysfunction: AUA guideline. J Urol. 2018; 200(3):633-641. Link, Google Scholar 21. . Molecular pathophysiology of priapism: emerging targets. Curr Drug Targets. 2015; 16(5):474-483. Google Scholar 22. . The molecular basis for the prothrombotic state in sickle cell disease. Haematologica. 2020; 105(10):2368-2379. Google Scholar 23. . Priapism in sickle cell disease: associations between NOS3 and EDN1 genetic polymorphisms and laboratory biomarkers. PLoS One. 2021; 16(2):e0246067. Google Scholar 24. . Men with sickle cell anemia and priapism exhibit increased hemolytic rate, decreased red blood cell deformability and increased red blood cell aggregate strength. PLoS One. 2016; 11(5):e0154866. Google Scholar 25. . Priapism secondary to leukemia: effective management with prompt leukapheresis. Int J Urol. 2004; 11(9):809-810. Google Scholar 26. . Clinical and genetic predictors of priapism in sickle cell disease: results from the recipient epidemiology and donor evaluation study III Brazil cohort study. J Sex Med. 2019; 16(12):1988-1999. Google Scholar 27. . Does platelet activity play a role in the pathogenesis of idiopathic ischemic priapism?Int Braz J Urol. 2016; 42(1):118-122. Google Scholar Google Scholar Submitted March 2, 2022; accepted August 30, 2022; published September 9, 2022. Support: None. Conflict of Interest: MLE: Advisor to Ro, Hannah, Underdog, Sandstone, Dadi, and consultant to Gilead. Ethics Statement: In lieu of a formal ethics committee, the principles of the Helsinki Declaration were followed. Data Availability: Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1TR003142) and from Internal Stanford funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Editor's Note: This article is the fifth of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 301 and 302. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited bySiemens D (2022) This Month in Adult UrologyJournal of Urology, VOL. 209, NO. 1, (1-2), Online publication date: 1-Jan-2023.Related articlesJournal of Urology11 Oct 2022Editorial Comment Volume 209Issue 1January 2023Page: 253-260Supplementary Materials PEER REVIEW REPORT Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.Keywordscerebrovascular disorderscardiovascular systempriapismMetricsAuthor Information Evan Mulloy Department of Urology, Stanford University School of Medicine, Palo Alto, California More articles by this author Shufeng Li Department of Urology, Stanford University School of Medicine, Palo Alto, California Department of Dermatology, Stanford University School of Medicine, Palo Alto, California More articles by this author Federico Belladelli Department of Urology, Stanford University School of Medicine, Palo Alto, California Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy More articles by this author Francesco Del Giudice Department of Urology, Stanford University School of Medicine, Palo Alto, California Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Rome, Italy More articles by this author Frank Glover Emory University School of Medicine, Atlanta, Georgia More articles by this author Michael L. Eisenberg Department of Urology, Stanford University School of Medicine, Palo Alto, California *Correspondence: Stanford University Department of Urology Center for Academic Medicine, 453 Quarry Road, Urology 5656, Palo Alto, California 93404 telephone: 650-725-5746; E-mail Address: [email protected] More articles by this author Expand All Submitted March 2, 2022; accepted August 30, 2022; published September 9, 2022. Support: None. Conflict of Interest: MLE: Advisor to Ro, Hannah, Underdog, Sandstone, Dadi, and consultant to Gilead. Ethics Statement: In lieu of a formal ethics committee, the principles of the Helsinki Declaration were followed. Data Availability: Data for this project were accessed using the Stanford Center for Population Health Sciences Data Core. The PHS Data Core is supported by a National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1TR003142) and from Internal Stanford funding. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Editor's Note: This article is the fifth of 5 published in this issue for which Category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 301 and 302. Advertisement PDF downloadLoading ...