We found great pleasure and interest in the recently published article in the International Journal of Impotence Research (IJIR) by Pyrgidis et al. [1], who conducted a comprehensive analysis of the extensive German nationwide inpatient database to systematically evaluate cases of low- and high-flow priapism requiring hospitalization.
According to American Urological Association (AUA) guideline for the management of priapism, the treatment approach for these conditions varies significantly due to their urgency; low-flow priapism requires prompt management starting with conservative measures like sympathomimetic drugs, progressing to shunt surgery or, if necessary, penile prosthesis implantation. High-flow priapism, less urgent in nature, may require selective arterial embolization if conservative methods fail [2, 3].
Pyrgidis et al. collected data from the German national database spanning 2008 to 2021, encompassing 6588 cases of low-flow priapism and 729 cases of high-flow priapism. They noted a median age of 49 years for low-flow priapism and 39 years for high-flow priapism, with sickle cell disease contributing to a minority of cases. The treatment interventions, including 1477 patients underwent shunt surgery for low-flow priapism, with a small subset receiving penile prostheses due to resultant erectile dysfunction, contributing to increased hospital costs.
Interestingly, the study underscored the role of penile prosthesis in managing priapism-related erectile dysfunction, despite limited high-quality evidence supporting its efficacy [3]. It also pointed out an increasing incidence of priapism cases over the studied years, particularly low-flow priapism requiring shunt surgeries, while high-flow priapism cases showed a declining trend [1].
In conclusion, while this study provides valuable insights into priapism trends and management practices within the German population, there appears to be emphasis on the need for further large-scale studies at global scale to further enhance global understanding and treatment protocols for this condition [1].
References
Pyrgidis N, Schulz GB, Chaloupka M, Volz Y, Pfitzinger PL, Berg E, et al. Trends and outcomes of hospitalized patients with priapism in Germany: results from the GRAND study. Int J Impot Res. 2024. https://doi.org/10.1038/s41443-024-00915-5.
Bivalacqua TJ, Allen BK, Brock GB, Broderick GA, Chou R, Kohler TS, et al. The diagnosis and management of recurrent ischemic priapism, priapism in sickle cell patients, and non-ischemic priapism: an AUA/SMSNA guideline. J Urol. 2022. https://www.auajournals.org/doi/10.1097/JU.0000000000002767.
Velasquez DA, Guimaraes PVB, Lescay H, Raheem O. Penile prosthesis in priapism: a systematic review of outcomes and complications. Transl Androl Urol. 2024;13:57483–583.
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Marcelo Mass Linderbaum (MML), David A Velasquez (DAV) and Omer A Raheem (OAR) equally contributed with manuscript contextual structure, writing and editing. OAR contributed with manuscript writing, finalizing and approval for submission.
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Lindenbaum, M.M., Velasquez, D.A. & Raheem, O.A. Comment on: Trends and outcomes of hospitalized patients with priapism in Germany: results from the GRAND study. Int J Impot Res (2024). https://doi.org/10.1038/s41443-024-00980-w
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DOI: https://doi.org/10.1038/s41443-024-00980-w
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