Is Phenylephrine injection effective for treating ischemic priapism? Study sheds light
USA: Non-surgical resolution of acute ischemic priapism (AIP) with phenylephrine is not dose-dependent, and hemodynamic changes that occur after phenylephrine administration may not be reported well, states a study published in the journal Urology. This implies that caution should be taken concerning high medication doses due to an apparent lack of improved efficacy.
Ischaemic priapism is a rare condition characterized by the inability of blood to leave the penis, causing pain and prolonged erection of the penis. Prompt treatment is required to restore the blood flow, prevent erectile dysfunction, and prevent necrosis.
Against the above background, Ethan Matz, Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, NC, and colleagues conducted the study to determine the efficacy and safety of hourly, high-dose phenylephrine (>1000 μg) for AIP through observing adverse hemodynamic events amongst risk profiles.
For this purpose, the researchers conducted an IRB-approved retrospective review from 2010-2020 of patients with acute ischemic priapism. Patients were categorized into a low or high-dose phenylephrine group based on cumulative, hourly doses of ≤1000 μg and > 1000 μg, respectively. They were investigated for successful resolution of their AIP. They also examined the safety profile of phenylephrine for patients at risk for adverse hemodynamic events.
Based on the study, the authors revealed the following:
· The researchers identified 123 patients with a median age of 40 years with a median time from AIP onset to a presentation of 11 hours.
· 78.% of men received phenylephrine, and detumescence was achieved nonoperatively in 63.9% of men, and a mean priapism duration was 8.7 hours.
· Those treated with phenylephrine had a mean duration of 8.8 ± 5.6 versus 57.3 ± 37.1 hours without resolution.
· Among low and high-dose phenylephrine groups (500 and 2000 μg, respectively), the median duration of AIP was 10 and 12 hours without a difference in AIP resolution.
· 17.1% of patients were at risk for phenylephrine complications, of which 4.1% had phenylephrine discontinued due to hemodynamic changes.
"Nonoperative treatment of AIP with phenylephrine does not appear to be dose-dependent and hemodynamic changes secondary to phenylephrine administration may be underreported," the researchers wrote.
"Future research should utilize standardized risk assessment and periprocedural monitoring for hemodynamic change," they conclude.
Reference:
Scarberry K, Deebel NA, Dutta R, Matz E, Terlecki RP. Safety and efficacy of Phenylephrine administration for the treatment of ischemic priapism: An opportunity for quality improvement in periprocedural safety assessment. Urology. 2022 Aug 22:S0090-4295(22)00709-9. doi: 10.1016/j.urology.2022.08.011. Epub ahead of print. PMID: 36007685.
