Introduction: Priapism is a painful, debilitating condition that burdens sexually active men. While the sequelae of priapism including recurrent priapism episodes, erectile dysfunction, or Peyronie’s disease are well known, the association with other health conditions are unknown. We therefore sought to define other health conditions diagnosed in men in the year after a priapism episode.
Methods: Using Optum® de-identified Clinformatics Datamart (SES view), a large commercial claims data warehouse, we evaluated all men (age >=18) with a diagnosis of priapism from 2003-2020 and matched them to a cohort of men with another urologic male penile disorder (i.e. erectile dysfunction (ED)). Demographic and geographic patient information was obtained. We identified incident disease (e.g. heart disease, embolism, thromobosis, cerebrovascular disease, cancer, endocrine disorders, immune disorders, inflammatory disorders). Follow up time was calculated from the index date until the incident diagnosis or end of enrollment time. Analyses were adjusted for age, year of diagnosis, race, education, income, geographic region, and visits per year.
Results: 9,004 men with priapism were matched (2:1) to 17,403 men with ED. The average age of men was 50.6 years old. The racial distribution for men with priapism was 65% White, 12% Black, 10% Hispanic, 10% Other, and 1% Asian. Overall, 3% of men with a history of priapism subsequently develop venous thrombosis/embolism compared to 2.2% of controls. After multivariable adjustment, men with history of priapism had a higher risk of embolism (HR 1.21, 95% CI 1.04-1.42). When examining pulmonary embolism specifically, 1.3% of men with priapism developed PE compared to 0.88% of controls. After adjustment, the risk remained elevated for men with a history of priapism (HR 1.30, 1.02-1.65). Incident cerebrovascular disease was also more likely in men with a history of priapism (HR 1.11, 1.01-1.21). In contrast, cancers (HR 0.87, 0.82-0.92) and endocrine disorders (HR 0.94, 0.89-0.998) were less common. Given the association with sickle cell anemia and thrombotic disease, we performed a sensitivity analysis after excluding men with sickle cell anemia were excluded from the analysis with similar interpretation.
Conclusions: Men with priapism, even in the absence of sickle cell anemia, may be at increased risk for venous thrombotic/embolic events. Future studies should be performed to determine if additional evaluation or follow up of men with priapism is warranted beyond examination for sexual dysfunction.
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