Research confirms no causal hyperlink between COVID-19 and ischemic priapism

In a latest examine printed within the Worldwide Journal of Impotence Analysis, a gaggle of researchers assessed the connection between Coronavirus Illness-19 (COVID-19) and ischemic priapism in sufferers handled at three college hospitals in Egypt between April 2020 and June 2022. Ischemic priapism is a uncommon situation the place blood will get trapped within the erection chambers of the penis.

Research: The connection between Coronavirus Illness-19 (COVID-19) and ischemic priapism: a case-control examine. Picture Credit score: Design_Cells / Shutterstock

Background 

On March 11, 2020, the World Well being Group (WHO) declared COVID-19 a pandemic. The illness has profoundly impacted medical, social, financial, and environmental points of life, resulting in widespread lockdowns. By March 24, 2024, the WHO reported 775,132,086 confirmed circumstances and seven,042,222 deaths. COVID-19 signs fluctuate broadly, with fever, cough, and anosmia being widespread. Extreme circumstances typically exhibit hypercoagulability, growing the chance of thromboembolic problems, together with ischemic priapism, a urological emergency brought on by sinusoidal thrombosis. Additional analysis is required to find out whether or not the affiliation between COVID-19 and ischemic priapism is causal or merely coincidental.

Concerning the examine 

The current examine retrospectively reviewed sufferers with priapism at three college hospitals from April 2020 to June 2022. In the course of the COVID-19 pandemic, all emergency division sufferers had been assessed for COVID-19 utilizing chest computed tomography (CT), full blood rely (CBC), C-reactive protein (CRP), and D-dimer checks, adopted by polymerase chain response (PCR) for suspicious circumstances. A optimistic PCR check confirmed COVID-19 positivity.

Priapism sufferers had been evaluated for period, ache, drug historical past, trauma, systemic illness, and recurrence. After knowledgeable consent, cavernosal aspiration was carried out by inserting a needle into the penile cavernosal tissue, aspirating blood, and irrigating with saline and Ephedrine hydrochloride till detumescence. Blood samples had been analyzed, and a distal shunt process was carried out if detumescence was not achieved inside an hour.

Knowledge collected included age, co-morbidity, priapism sort, episode period, cavernous blood gases, chest CT findings, lymphocyte share, CRP, D-dimer ranges, COVID-19 course, priapism administration, and follow-up erectile perform. Sufferers had been labeled into two teams primarily based on COVID-19 presence, and standards had been in contrast, together with erectile perform assessed utilizing the Worldwide Index of Erectile Operate-5 (IIEF-5). Statistical evaluation used the Kolmogrov-Smirnov Z, t-tests, Mann-Whitney U, and Chi-square checks, with significance at p ≤ 0.05.

Research outcomes 

In the course of the examine interval, 43 sufferers with ischemic priapism had been recognized, with a median age of 36 years and a median priapism period of 8 hours. Amongst these sufferers, 2.3% had persistent kidney illness, 6.97% had hypertension, and 16.3% had diabetes. The sufferers had been divided into two teams: 30 sufferers with ischemic priapism solely (Group I) and 13 sufferers with each ischemic priapism and COVID-19 (Group II).

Cavernosal aspiration was profitable in 83.3% of sufferers in Group I and 92.3% in Group II, exhibiting no vital distinction (P = 0.4). Recurrence of priapism occurred in 16.7% of sufferers in Group I, whereas no recurrences had been noticed in Group II (P = 0.1). On the final follow-up, reasonable erectile dysfunction (ED) developed in 6.7% and extreme ED in 13.3% of sufferers in Group I. In Group I, these with extreme ED had been managed with a distal shunt and ready for penile prosthesis placement, apart from one affected person who developed reasonable ED after the distal shunt. In Group II, one affected person (7.7%) developed extreme ED after distal shunting and was additionally ready for penile prosthesis implantation. The median period of ischemic priapism was considerably longer in sufferers with extreme ED in comparison with these with out (19 vs. 7 hours, P = 0.01).

There have been no statistically vital variations between the 2 teams when it comes to age (P = 0.8), required priapism administration (P = 0.4), priapism recurrence (P = 0.1), and ED severity (P = 0.5).

In Group II, priapism was the principle presenting symptom in 30.8% of sufferers, resulting in the incidental prognosis of COVID-19. Different sufferers offered with various levels of COVID-19 signs: gentle in 5 sufferers, reasonable in 2 sufferers, and extreme in 2 sufferers. Sufferers with priapism and gentle COVID-19 signs had been handled with house isolation and supportive care, together with vitamin C, zinc, lactoferrin, acetylcysteine, paracetamol, and ivermectin. These with reasonable signs obtained related remedy together with intravenous ivermectin, anticoagulants, and steroids, whereas extreme circumstances had been referred for hospital isolation. All COVID-19 sufferers recovered utterly after remedy.

Sufferers with gentle and reasonable COVID-19 signs responded properly to cavernosal aspiration, maintained erectile perform, and didn’t expertise priapism recurrence. These with extreme COVID-19 signs additionally responded properly to cavernosal aspiration, with one affected person creating gentle ED. 

Conclusions 

To summarize, this examine, the most important on ischemic priapism in COVID-19 sufferers, discovered that priapism occurred throughout all COVID-19 severity ranges. COVID-19 didn’t alter priapism remedy protocols or post-treatment erectile perform. The findings recommend a coincidental fairly than causal relationship between COVID-19 and ischemic priapism.