title: Malleable penile prosthesis is a cost-effective treatment for refractory ischemic priapism.
abstract: BACKGROUND
  Refractory ischemic priapism (RIP) can be difficult to treat, consuming significant healthcare-related resources. Acute insertion of a malleable penile prosthesis (MPP) has been reported as an effective therapy that treats the priapism and restores sexual function.
  
  
  OBJECTIVE
  We report our 6-year, urban public hospital experience with acute insertion of MPP in patients with RIP.
  
  
  METHODS
  We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007 to 2013. Data analyzed included duration of erection, number of emergency room (ER) visits, hospital admissions, days of hospitalization, and postoperative course. Costs were estimated using standard Medicare reimbursement rates.
  
  
  METHODS
  Healthcare-related costs of treatment of RIP episodes in men presenting to our institution.
  
  
  RESULTS
  During the study period, 14 men underwent MPP placement acutely for refractory priapism. Thirteen presented with RIP, and one had stuttering priapism over a 14-day hospitalization. Etiologies included sickle cell anemia (4/13, 29%), medication-induced (3/14, 21%), and idiopathic (7/14, 50%). Average preoperative duration of RIP was 82 hours with considerable consumption of health-care resources (average US $83,818 estimated cost, 4 ER visits [range 1-27], 2 hospital admissions [range 1-5], 1.5 shunt procedures [range 1-3], 5 irrigation and drainage procedures using phenylephrine injection [range 2-20], and 5 hospital admission days [range 2-14]). All patients were discharged within 24 hours of MPP surgery.
  
  
  CONCLUSIONS
  The management of RIP is associated with multiple ER visits, prolonged hospital admissions, and significant resource utilization. MPP insertion is efficacious for the immediate resolution of refractory priapism, with potential cost and resource benefits.
authors.affiliation: Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Tausch
authors.forename: Lee C
authors.initials: LC
authors.lastname: Zhao
authors.forename: Allen F
authors.initials: AF
authors.lastname: Morey
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Siegel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Belsante
authors.forename: Casey A
authors.initials: CA
authors.lastname: Seideman
authors.forename: James R
authors.initials: JR
authors.lastname: Flemons
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D007267:Injections / Q000009:adverse effects; D007511:Ischemia / Q000150:complications; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data*; D010410:Penile Erection / Q000523:psychology; D019935:Penile Implantation / Q000009:adverse effects; D015917:Penile Prosthesis / Q000191:economics*; D010413:Penis / Q000503:physiopathology / Q000601:surgery*; D010656:Phenylephrine / Q000191:economics / Q000494:pharmacology; D011317:Priapism / Q000191:economics / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010656:Phenylephrine
keywords: Erectile Dysfunction; Penile Prosthesis; Priapism