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Is urgent surgical management necessary for priapism in pediatric patients with hematologic conditions?
Sagar R Patel1, Amit Reddy1, Michelle Dai1
1Division of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
Insights
Pediatric acute priapism, often linked to sickle cell disease, can be effectively managed with conservative treatments like oxygen and hydration, or minimally-invasive procedures. Operative management and general anesthesia are rarely needed for these cases.
Area of Science:
- Pediatric Urology
- Hematology
- Emergency Medicine
Background:
- Acute priapism is a pediatric emergency requiring prompt evaluation and treatment.
- Sickle cell disease is a primary cause of priapism in children and adolescents.
- Optimal management strategies for pediatric priapism are continuously being researched.
Purpose of the Study:
- To compare the effectiveness of conservative, minimally-invasive, and operative management for acute priapism in pediatric patients.
- To identify differences in treatment approaches based on the etiology of priapism.
- To assess the necessity of surgical intervention and general anesthesia in pediatric priapism cases.
Main Methods:
- A retrospective study analyzed 61 cases of acute pediatric priapism from 2015 to 2021 at a children's hospital.
- Patient data included demographics, medical history (especially sickle cell disease), and priapism management strategies.
- Treatments evaluated were conservative (oxygen, hydration), minimally-invasive (corporal injection, aspiration/irrigation), and operative (shunting).
Main Results:
- Hematologic disorders, particularly sickle cell disease, were the most common causes (72% of patients).
- Conservative and minimally-invasive treatments achieved resolution in a majority of cases (60% and 35.5% for hematologic priapism, respectively).
- Operative management, including shunting, was infrequently required across all etiologies.
Conclusions:
- Conservative and minimally-invasive strategies are highly effective for managing pediatric acute priapism, especially when associated with hematologic disorders.
- Minimally-invasive approaches can often avoid the need for surgery and general anesthesia in children.
- A conservative, minimally-invasive management strategy is recommended for pediatric priapism to preserve penile function and minimize resource utilization.
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:
While urgent surgical management is often performed in the adult population, a minimally-invasive management strategy can be implemented in the pediatric population where an extended period of conservative management that avoids operative management and general anesthesia is effective.
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