Emergency Department Evaluation of Priapism: Etiology and Consultation

Introduction: Priapism is a time-critical condition requiring immediate evaluation and management to avoid significant sequela. Management of this condition is significantly variable, dependent upon the underlying cause, and often instituted by a consultant rather than the treating emergency physician. Objectives: To determine etiologic factors contributing to priapism treatment and determine if treatments initiated in the emergency department (ED) contribute to an improved disposition metric. Methods: We conducted a multi-center, retrospective study of patients with priapism caused by multiple different etiologies. Study subjected were located at 15 hospitals by chart review and conducted a computer-assisted chart review to locate patients with priapism for each hospital over a 2-year period. Results: We evaluated 236 patients during the study period; 8 excluded for chart unavailable and 6 with non-priapism diagnosis on review. Median age was 39 years (IQR 22-52). Pediatrics, defined as less than 21 years of age, comprised 4% of patients (N=9). Overall, 85% (N=188) were discharged. Erectile dysfunction medications (EDM) were the most common identifiable cause; involving 23% (N=52). The remaining were sickle cell 20% (N=45), antipsychotic medications 14% (N=30), cocaine 2% (N=4), the remainder without an identifiable etiology. Overall, intrapenile procedures occurred in 56% (N=125) of patients. EDM was associated with significantly less intrapenile procedures compared to other etiologies, 15% (N=58) (p = 0.009), and also had a 2% (N=1) admission rate, significantly less compared to other etiologies (p=0.009). Further, consulting urology did not significantly increase mean length of stay, with difference of 19 minutes (p=0.64) when compared to ED intervention alone. Conclusion: Priapism as a result of EDM, the most frequent etiology, was associated with less frequent emergent intrapenile procedures and significantly less admissions and urology consultation does not significantly lengthen disposition times.