Trends In the Hospital Treatment of Sickle Cell Disease-Related Priapism In the United States: 1998 to 2007,

Priapism is a serious complication of sickle cell disease (SCD). Urologic guidelines recommend that the management of priapism should entail intracavernous treatment in addition to treatment for the underlying condition. One meta-analysis suggests that transfusion is an ineffective and potentially harmful therapy for priapism in SCD. Nevertheless, little is known about how priapism is actually managed for these patients. We examined in-hospital treatment trends of priapism among male SCD patients in the United States (US) over a 10-year period with a focus on the use of blood transfusion.

This is a retrospective analysis of the Nationwide Inpatient Sample (1998 – 2007). Priapism patients were identified based on ICD-9 code 607.3. The analysis was restricted to male patients with an ICD-9 code for SCD. We assessed the total number of priapism discharges over time and by year. We also assessed the overall and annual prevalence of blood transfusions, exchange blood transfusions (EBTs), and penile surgeries for all discharges under study. We postulated that transfusions given in patients not undergoing surgery were likely given as primary treatment in the management of priapism.

An estimated 502,577 qualifying male SCD hospitalizations were identified. Among these, 9,861 (2%) were priapism-related. The mean age of the male SCD hospitalizations was 24.9, with only a 1 year difference found between non-priapism and priapism discharges. The proportion of priapism related hospitalizations remained stable over time, ranging from 1.7% to 2.4% (p = 0.359). Overall, priapism related discharges were more likely than non-priapism related discharges to be treated with blood transfusions (36.3% vs. 22.6%, p < 0.0001), EBTs (7.6% vs. 1.0%, p < 0.0001), and penile surgeries (14.3% vs. < 0.1%, p < 0.0001). There was no association between the prevalence of penile surgery and blood transfusions among priapism discharges over the entire time period, and there was no evidence that the association between penile surgeries and blood transfusions for priapism patients changed over time. Approximately 14% of priapism discharges with no blood transfusion underwent penile surgery compared to 15.2% of priapism discharges with a blood transfusion (p = 0.411). Linear trend analyses revealed a 9% increase each year in the use of blood transfusions as a treatment for all male SCD hospitalizations, regardless of priapism status (OR = 1.09, p < 0.001). Adjusting for the temporal trend, priapism related discharges were nearly twice as likely as non-priapism related discharges to be treated with blood transfusions of any type (OR = 1.99, p < 0.001). There was, however, a significant association between the prevalence of penile surgery and exchange blood transfusions among priapism patients as 27.1% of priapism discharges with an exchange transfusion underwent penile surgery compared to 13.2% of discharges without an exchange transfusion (p < 0.0001). There was no evidence of a significant linear trend in the use of EBT in the treatment of any male SCD hospitalization over time (OR = 1.01, p = 0.691). Overall, priapism related discharges were 8-times more likely than non-priapism related discharges to be treated with EBT (OR = 8.1, p < 0.001). There was no significant linear temporal trend in the use of penile surgeries in the treatment of priapism related discharges (OR = 1.04, p = 0.209). Priapism discharges in which a penile surgery occurred were more than twice as likely to receive an exchange blood transfusion than those priapism discharges without a penile surgery (OR = 2.42, p < 0.001).

The use of EBT and penile surgeries in the treatment of priapism related SCD discharges appears to be relatively stable over time, while there has been an increase in the use of blood transfusions of any kind for all male SCD hospitalizations, including those with priapism. The lack of an association between the prevalence of blood transfusions of any type and the use of penile surgery among priapism patients suggests that blood transfusions continue to be used as a primary treatment modality for priapism, even though data to support the effectiveness of transfusion is lacking. Patient and hospital-level factors that may impact the use of different treatment options for priapism need to be assessed, and the outcomes of the variations in the treatment of priapism related SCD hospitalizations should be examined.

No relevant conflicts of interest to declare.