Priapism Increases the Risk of Cardiovascular and Cerebrovascular Disease in Men

Comments from Dr. Peter Schlegel

Written by Peter N. Schlegel MD, FACS

Practice Update, 10/25/2022 - The article by Mulloy et al in J Urology raises additional considerations for the management of men with priapism. The authors evaluated over 10,000 men using an administrative database, comparing the risk of developing subsequent cardiovascular, cerebrovascular and thromboembolic disease men with a history of priapism. The men with priapism had a 24% higher risk (OR, 1.24) of subsequent disease relative to men with a history of erectile dysfunction, Peyronie's disease or premature ejaculation. This means that even men who are already at risk for cardiovascular disease (men with ED) have a lower risk of subsequent vascular disease than men with priapism. The authors appropriately removed men with a diagnosis of sickle cell disease from the priapism patients, emphasizing the relevance of these observations for men with idiopathic priapism. The study has the usual limitations: The data are based on coding with ICD-10 and CPT codes, and the database is almost exclusively based on patients who have commercial insurance.

Taken together, the observed increased risk of cardiovascular disease for men with priapism has important clinical implications. This is not easy for the urologist caring for men with priapism. Not only do you have to be circumspect with patients regarding the risk of subsequent erectile dysfunction, especially with longer duration of priapism, but these data now suggest that we should counsel men about the increased incident risk of cardiovascular disease. Such concern could appropriately lead to cardiology or other focused referral after treatment for priapism.

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