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Which patients with ischaemic priapism require further investigation for malignancy?
International Journal of Impotence Research ( IF 2.6 ) Pub Date : 2019-04-17 , DOI: 10.1038/s41443-019-0141-z
Mark James Johnson , Marcus Hallerstrom , Hussain M. Alnajjar , Thomas Frederick Johnson , Marta Skrodzka , Giovanni Chiriaco , Asif Muneer , David James Ralph

Ischaemic priapism (IP) is characterised by a persistent, painful penile erection lasting for >4 h. Many causes of IP have been identified including haematological dyscrasias (particularly, sickle cell disease), drugs and rarely malignancy. There are also a large proportion of men, in which no aetiology is identified. Identification of men at risk for malignancy provides a diagnostic challenge to the clinicians looking after these patients. All cases of IP between 2007 and 2017 at a single tertiary andrology unit were identified. The case notes and electronic records of these patients were reviewed to identify cases of malignant priapism. Men with idiopathic IP were used as a control group for comparative statistics. In total, 412 men with IP were identified, 202 of which had idiopathic IP. Within this group, the prevalence of malignant priapism was 3.5% (n = 11). MP secondary to local invasion or penile metastases occurred in seven of the 11 men (bladder × 3, prostate, lung, urethral and chondrosarcoma of the pelvis). MP secondary to haematological malignancy occurred in the remaining four (chronic myeloid leukaemia × 2, chronic lymphocytic leukaemia, and myelodysplasia). IP was the initial presentation of malignancy in seven of the patients (64%). An abnormally low haemoglobin value (reference range 130–180 g/dl) was found in 82% (n = 9) of the men with MP. The mean haemoglobin value in men with MP was 109.64 ± 20.30 g/dl compared to the control of 131.87 ± g/dl. This difference was considered highly significant p = 0.0046. Men with MP also appear to have a very poor prognosis with an 18-month mortality of 64% (n = 7). Malignancy is a rare and important cause of IP. A low haemoglobin is a predictor of malignancy and warrants further investigation in IP.



中文翻译:

哪些缺血性阴茎异常勃勃的患者需要进一步检查恶性肿瘤?

缺血性阴茎异常勃起(IP)的特征是持续性疼痛性阴茎勃起持续> 4 h。已经确定了许多IP病因,包括血液动力学异常(特别是镰状细胞病),药物和恶性肿瘤。男性中也有很大一部分没有发现病因。识别具有恶性肿瘤风险的男性为照顾这些患者的临床医生提出了诊断挑战。确定了2007年至2017年间在一个单一的男科学部门的所有IP病例。审查了这些患者的病历笔记和电子记录,以鉴定恶性普瑞斯病的病例。患有特发性IP的男性被用作对照组进行比较统计。总共鉴定出412名具有IP的男性,其中202名患有特发性IP。在这个小组中n  = 11)。11名男性中有7名发生了继发于局部浸润或阴茎转移的MP(膀胱×3,前列腺,肺,尿道和骨盆软骨肉瘤)。其余四位(继发性骨髓性白血病×2,慢性淋巴细胞性白血病和骨髓增生异常)发生于血液系统恶性肿瘤的MP。IP是七名患者(64%)中恶性肿瘤的最初表现。 在患有MP的男性中,有82%(n = 9)的人发现血红蛋白值异常低(参考范围130–180 g / dl)。MP男性患者的平均血红蛋白值为109.64±20.30 g / dl,而对照组为131.87±g / dl。该差异被认为是非常显着的,p  = 0.0046。患有MP的男性预后也很差,18个月死亡率为64%(n  = 7)。恶性肿瘤是IP的罕见且重要原因。低血红蛋白是恶性肿瘤的预测指标,因此有必要对IP进行进一步研究。

更新日期:2019-05-16
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