Rare Disorders of Painful Erection: A Cohort Study of the Investigation and Management of Stuttering Priapism and Sleep-Related Painful Erection
Rare Disorders of Painful Erection: A Cohort Study of the Investigation and Management of Stuttering Priapism and Sleep-Related Painful Erection
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DOI：
10.1016/j.jsxm.2020.11.010
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发表时间：
2021-02-04
影响因子：
3.5
通讯作者：
Ralph, David J.
中科院分区：
文献类型：
--
作者：
Johnson, Mark James;McNeillis, Venkata;Ralph, David J.
背景：患有口吃性异常勃起（SP）和睡眠相关性勃起疼痛（SRPE）的男性的主要症状是令人烦恼的夜间勃起，这会唤醒他们并导致睡眠质量差和白天疲劳。 SP 和 SRPE 是罕见的实体，它们的临床特征相似，但需要不同的治疗方法。目的：本研究的目的是描述 SP 和 SRPE 男性的临床特征、调查和有效的治疗选择。方法：对 2004 年至 2018 年间在三级男科就诊的 133 名患有夜间勃起疼痛的男性进行回顾性队列研究。这些男性分为 3 组。第 1 组 (n = 62) 包含患有镰状细胞 SP 的男性；第 2 组 (n = 40) 包含患有非镰状细胞 SP 的男性，第 3 组 (n = 31) 包含患有 SRPE 的男性。结果：确定内科和手术治疗对患有 SP 和 SRPE 的男性的有效性。结果：羟基脲和自动换血是镰状细胞 SP 组中最有效的治疗选择。激素控制和α-激动剂疗法在两个 SP 队列（第 1 组和第 2 组）中均有效。巴氯芬是治疗 SRPE 男性最有效的疗法。对于药物治疗失败的男性，植入阴茎假体可使 SP 男性（第 1 组和第 2 组）的症状完全缓解。手术治疗（阴茎假体植入和栓塞）并没有改善 SRPE 组患者的症状。临床意义：本研究区分了镰状细胞 SP、非镰状细胞 SP 和 SRPE，并描述了每组的有效治疗方案。优点和局限性：这分别是 SP 和 SRPE 最大的队列研究。局限性包括其回顾性和单中心经验。结论：根据建议的治疗途径对这 3 组男性进行不同的管理，为这些罕见疾病的管理提供了一种更加结构化的方法。版权所有 (C) 2020，国际性医学学会。由爱思唯尔公司出版。保留所有权利。
Background: A chief complaint of men with stuttering priapism (SP) and sleep-related painful erections (SRPE) is bothersome nocturnal erections that wake them up and result in poor sleep and daytime tiredness. SP and SRPE are rare entities that have similarities in their clinical features, but that require different treatment approaches.Aim: The aim of this study was to describe the clinical features, investigations, and effective management options for men with SP and SRPE.Methods: Retrospective cohort study of 133 men with bothersome nocturnal painful erections that attended a tertiary andrology unit between 2004 and 2018. These men were divided into 3 groups. Group 1 (n = 62) contains men with sickle cell SP; group 2 (n = 40) has men with non-sickle cell SP and group 3 (n = 31) contains men with SRPE.Outcome: To determine the effectiveness of medical and surgical treatments for men with SP and SRPE.Results: Hydroxyurea and automated exchange transfusion were the most effective treatment options in the sickle cell SP group. Hormonal manipulation and a-agonist therapies were effective in both SP cohorts (groups 1 and 2). Baclofen was the most effective therapy in men with SRPE. For men who failed medical management, implantation of a penile prosthesis resulted in complete resolution of the symptoms in men with SP (groups 1 and 2). Surgical management (penile prosthesis implantation and embolization) did not improve the patients' symptoms in the SRPE group.Clinical Implications: This study differentiates between sickle cell SP, non-sickle cell SP, and SRPE and describes effective treatment options for each group.Strengths & Limitations: This is the largest cohort study for both SP and SRPE, respectively. Limitations include its retrospective nature and single-center experience.Conclusion: Managing men in these 3 groups differently and in accordance with the proposed treatment pathway provides a more structured approach to the management of these rare conditions. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.