Location
Philadelphia, PA
Start Date
1-5-2024 1:00 PM
End Date
1-5-2024 4:00 PM
Description
Introduction:
While AUA guidelines recommend a specific protocol for managing acute ischemic priapism, its implementation varies between emergency department (ED) providers and urologists. The absence of well-established dosing guidelines for phenylephrine further compounds its variability. Our study aims to assess the divergence in practice patterns between ED staff and urologists in the management of priapism, with a particular focus on the use of corporal blood gas and intracavernosal (IC) phenylephrine injection.
Methods:
We queried Epic electronic health records (EHR) from four Philadelphia area community hospitals for ED encounters with priapism ICD-10 codes between January 2018 and February 2023. Exclusions included cases related to malignancy, operative intervention, corporoglanular shunt, or lacking documented phenylephrine dosing. Acute ischemic priapism was defined by painful erections. We recorded patient demographics and assessed the collection of corporal blood gas, IC phenylephrine utilization, and total IC phenylephrine dosage. We used unpaired t-tests for continuous variables and Pearson’s Chi-Squared tests for categorical variables, with p-values < 0.05 considered statistically significant.
Results:
The Epic EHR query resulted in 61 encounters. After exclusions, 48 encounters were studied (ED: n = 21, Urologists: n = 27). Twenty-five patients identified as African-American, 22 as White, and one as Asian-American. The average age was 50 years. 41% of cases were related to erectogenic IC injections. 14.2% had sickle cell disease or trait. Urologists collected corporal blood gas more frequently (Urologists: 67% vs. ED: 9%; p < 0.0001) and, on average, used a higher dose of phenylephrine (Urologists: 541 mcg vs. ED: 340 mcg; p = 0.089). IC phenylephrine utilization was similar between groups (Urologists: 81.5%, ED: 72.7%; p = 0.4651)
Discussion:
Our study found a high rate of priapism related to erectogenic intracavernosal injections, reflecting a recent shift in the primary etiology. We also note a significant difference in utilization of corporal blood gas between urologists and ED providers; however, there is not a significant difference in utilization or dosage of IC phenylephrine.
Embargo Period
7-1-2024
Included in
Comparing practice patterns in acute ischemic priapism management
Philadelphia, PA
Introduction:
While AUA guidelines recommend a specific protocol for managing acute ischemic priapism, its implementation varies between emergency department (ED) providers and urologists. The absence of well-established dosing guidelines for phenylephrine further compounds its variability. Our study aims to assess the divergence in practice patterns between ED staff and urologists in the management of priapism, with a particular focus on the use of corporal blood gas and intracavernosal (IC) phenylephrine injection.
Methods:
We queried Epic electronic health records (EHR) from four Philadelphia area community hospitals for ED encounters with priapism ICD-10 codes between January 2018 and February 2023. Exclusions included cases related to malignancy, operative intervention, corporoglanular shunt, or lacking documented phenylephrine dosing. Acute ischemic priapism was defined by painful erections. We recorded patient demographics and assessed the collection of corporal blood gas, IC phenylephrine utilization, and total IC phenylephrine dosage. We used unpaired t-tests for continuous variables and Pearson’s Chi-Squared tests for categorical variables, with p-values < 0.05 considered statistically significant.
Results:
The Epic EHR query resulted in 61 encounters. After exclusions, 48 encounters were studied (ED: n = 21, Urologists: n = 27). Twenty-five patients identified as African-American, 22 as White, and one as Asian-American. The average age was 50 years. 41% of cases were related to erectogenic IC injections. 14.2% had sickle cell disease or trait. Urologists collected corporal blood gas more frequently (Urologists: 67% vs. ED: 9%; p < 0.0001) and, on average, used a higher dose of phenylephrine (Urologists: 541 mcg vs. ED: 340 mcg; p = 0.089). IC phenylephrine utilization was similar between groups (Urologists: 81.5%, ED: 72.7%; p = 0.4651)
Discussion:
Our study found a high rate of priapism related to erectogenic intracavernosal injections, reflecting a recent shift in the primary etiology. We also note a significant difference in utilization of corporal blood gas between urologists and ED providers; however, there is not a significant difference in utilization or dosage of IC phenylephrine.
Comments
Presented by Kayla Meyer.