Attention: Restrictions on use of AUA, AUAER, and UCF content in third party applications, including artificial intelligence technologies, such as large language models and generative AI.
You are prohibited from using or uploading content you accessed through this website into external applications, bots, software, or websites, including those using artificial intelligence technologies and infrastructure, including deep learning, machine learning and large language models and generative AI.
UPJ INSIGHT Clinical Practice Patterns for Surgical Shunts and Penile Prosthesis Placement in Men With Priapism: A Retrospective Large Claims Database Analysis
By: Taylor P. Kohn, MD, MPhil, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; William DuComb, DO, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Kiran Sury, MD, Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Una Choi, BA, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Trinity J. Bivalacqua, MD, PhD, Perelman School of Medicine at the University of Pennsylvania, Philadelphia | Posted on: 20 May 2024
Kohn TP, DuComb W, Sury K, Choi U, Bivalacqua TJ. Clinical practice patterns for surgical shunts and penile prosthesis placement in men with priapism: a retrospective large claims database analysis. Urol Pract. 2024;11(3):507-513. doi:10.1097/UPJ.0000000000000558
Study Need and Importance
There is wide variation in the treatment and management of priapism when corporal cavernosal irrigation fails. Some providers will go directly to penile prosthesis, while others will try shunt procedures. Here we investigated practice patterns using a large retrospective claims database.
What We Found
Using TriNetX Diamond Network, we identified 6392 men with the diagnosis of priapism and the procedure of corpora cavernosal irrigation. Of these men, 693 (11%) proceeded to surgical shunt. One hundred forty-four men (2%) underwent initial penile prosthesis placement. Of the men undergoing initial penile prosthesis, only 17 of 144 (12%) cases occurred within the first month of corpora cavernosal irrigation (Table).
Table. Time to Initial Penile Prosthesis Placement
| Early (<1 mo) | Deferred (1-3 mo) | Delayed (3-12 mo) | Prolonged (>12 mo) | |
|---|---|---|---|---|
| 3-Piece inflatable penile prosthesis | ||||
| No. | 10 | 25 | 46 | 44 |
| Median time to placement (range), d | 5 (2-22) | 50 (31-87) | 165 (94-356) | 703 (369-1731) |
| 2-Piece inflatable penile prosthesis | ||||
| No. | 1 | 2 | 2 | 4 |
| Median time to placement (range), d | 1 | 32 (32-38) | 95 (95-176) | 944 (579-1481) |
| Semirigid penile prosthesis | ||||
| No. | 6 | 0 | 2 | 2 |
| Median time to placement (range), d | 1 (0-8) | − | 232 (232-364) | 1345 (398-2282) |
Limitations
This was a retrospective claims database analysis extracted from electronic medical records, and as such we lack important granularity from the data. Surgical shunt and penile prosthesis placements are rarely performed, and thus demographic, race, ethnicity, and diagnoses data are not available for some of the smaller outcome data.
Interpretation for Patient Care
Surgical shunting is currently the preferred treatment option as determined in this retrospective cohort. However, men receiving initial prostheses were more likely to be older and have preexisting erectile dysfunction, highlighting that patient selection remains a critical component of surgical management for patients with refractory ischemic priapism.
advertisement
advertisement