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Is urgent surgical management necessary for priapism in pediatric patients with hematologic conditions?

      Summary

      Introduction

      Acute priapism is usually considered a medical emergency that warrants prompt urologic evaluation and treatment. Efforts have been made to determine the optimal management strategy for pediatric priapism.

      Objective

      The aim of this study is to assess differences in conservative, minimally-invasive, and operative management of acute priapism in the pediatric population.

      Study design

      A retrospective study of pediatric patients with acute priapism from 2015 to 2021 at a single tertiary care children's hospital was conducted. Conservative, minimally-invasive, and operative approaches for the priapism episodes during these hospital encounters were analyzed.

      Results

      Thirty-nine patients were identified with a total of 61 cases of acute pediatric priapism were evaluated in the study period. Eight-three percent of patients were African-Americans, and 72% of patients had a history of sickle cell disease. Oxygen therapy (P = 0.001) and hydration with intravenous fluids (P = 0.00318) were more commonly utilized for hematologic-associated cases compared to other etiologies. For priapism episodes of hematologic etiology, 18 (40.0%) and 18 (40.0%) patients received phenylephrine injection and aspiration/irrigation (e.g., minimally-invasive therapy), respectively, while for the other causes of priapism, three (18.8%) and four (25.0%) received phenylephrine injection and aspiration/irrigation (e.g., minimally-invasive), respectively. Conservative and minimally-invasive treatment resulted in complete resolution of priapism in 27 (60%) and 16 (35.5%) patients with hematologic-associated priapism while 12 (75%) and 1 (6.3%) patients with other etiologies had resolution of priapism with conservative and minimally-invasive treatment, respectively. One patient received shunting in the hematologic group while two patients received shunting in the non-hematologic group (P = 0.1031).

      Discussion

      Hematologic disorders are the most common causes of priapism in children and adolescents. An overwhelming majority of priapism events in the pediatric population can be managed with conservative therapies including oxygenation and intravenous hydration as well as minimally-invasive procedures such as corporal aspiration, irrigation and/or injections. The utilization of corporal shunting, anesthesia, and hospital resources is infrequently necessary for pediatric priapism episodes.

      Conclusion

      Summary TableManagement strategies and resolution rates of acute pediatric priapisms based on hematologic and non-hematologic etiologies.
      Total Hematologic Other P-value
      Cases 61 45 16
      Penile Ultrasound 6 2 4 0.01778
      Corporal Blood Gas 6 5 1 0.57548
      Nasal Canula 25 24 1 0.001
      Intravenous Fluids 44 37 7 0.00318
      Transfusion 1 1 0 0.5485
      Conservative Therapy
       Resolution of Priapism 39 27 12 0.2872
      Minimally Invasive Intervention
       Phenylephrine Injection 0 0 0 0.5485
       Aspiration/Irrigation 2 1 1 0.4354
       Both 20 17 3 0.16452
       Resolution of Priapism 17 16 1 0.0230
      Operative Management
       Aspiration/Irrigation 2 1 1 0.4354
       Shunting 3 1 2 0.1031
       Resolution of Priapism 5 2 3 0.0731
      Anesthetic
       Ketamine 4 4 0 0.2187
       Midazolam 4 3 1 0.95216
       General Anesthesia 5 2 3 0.07346
      Medication of Stuttering Priapism
       Pseudoephedrine 18 18 0 0.00544
       Ketoconazole 3 3 0 0.28914

      Keywords

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