Early leukocyte-based inflammatory markers and ischemia duration are associated with the need for surgical shunting in acute ischemic priapism: an exploratory retrospective cohort study

Marcadores inflamatorios tempranos basados en leucocitos y duración de la isquemia se asocian con la necesidad de derivación quirúrgica en el priapismo isquémico agudo: un estudio de cohorte retrospectivo exploratorio

Background: Acute ischemic priapism is a time-dependent urological emergency in which failure of stepwise conservative treatment requires emergency surgical shunting, and prolonged cavernosal ischemia may cause permanent erectile dysfunction. The parameters available at presentation that identify which patients will fail conservative therapy and require shunting are poorly defined, and leukocyte-based inflammatory markers have not previously been examined in this emergency. We therefore assessed whether these parameters are associated with the need for surgical shunting, with post-priapism erectile dysfunction as a secondary outcome. Methods: Among 23 adults with acute ischemic priapism, 15 were managed conservatively and 8 required surgical shunting; admission leukocyte-based inflammatory markers and ischemia duration were examined for their association with the need for surgical shunting. Results: Patients who required shunting had a markedly longer ischemia duration (median 48 versus 7.5 hours) and a higher admission white blood cell count (median 13.3 versus 10.0 × 10⁹/L), with higher neutrophil and monocyte counts, whereas composite inflammatory indices such as the neutrophil-to-lymphocyte ratio and the systemic immune-inflammation index did not differ. The admission white blood cell count discriminated the need for surgical shunting with an area under the curve of 0.84, comparable to ischemia duration (0.82); a threshold of approximately 13 × 10⁹/L gave 75% sensitivity and 87% specificity, while the composite indices were non-discriminatory. The white blood cell count correlated only moderately with ischemia duration, indicating information not fully explained by elapsed time. Post-priapism erectile dysfunction, a secondary outcome, was related only to older age. Conclusions: In acute ischemic priapism, a longer ischemia duration and a higher early leukocyte count at presentation are associated with the need for emergency surgical shunting, whereas composite inflammatory indices are not; these simple, immediately available parameters may support early risk stratification and merit validation in larger, multicentre studies.

Resumen

Antecedentes: El priapismo isquémico agudo es una urgencia urológica dependiente del tiempo en la que el fracaso del tratamiento conservador escalonado obliga a realizar una derivación quirúrgica urgente, y la isquemia cavernosa prolongada puede causar disfunción eréctil permanente. Los parámetros disponibles en el momento de la presentación que permiten identificar qué pacientes fracasarán con el tratamiento conservador y requerirán derivación están poco definidos, y los marcadores inflamatorios basados en leucocitos no se habían examinado previamente en esta urgencia. Métodos: Entre 23 adultos con priapismo isquémico agudo, 15 fueron tratados de forma conservadora y 8 requirieron derivación quirúrgica; se examinaron los marcadores inflamatorios basados en leucocitos al ingreso y la duración de la isquemia en relación con la necesidad de derivación quirúrgica. Resultados: Los pacientes que requirieron derivación presentaron una duración de la isquemia notablemente mayor (mediana de 48 frente a 7.5 horas) y un recuento de leucocitos al ingreso más elevado (mediana de 13.3 frente a 10.0 × 10⁹/L), con recuentos de neutrófilos y monocitos más altos, mientras que los índices inflamatorios compuestos, como el índice neutrófilo-linfocito y el índice de inmunoinflamación sistémica, no difirieron. El recuento de leucocitos al ingreso discriminó la necesidad de derivación quirúrgica con un área bajo la curva de 0.84, comparable a la duración de la isquemia (0.82); un umbral de aproximadamente 13 × 10⁹/L proporcionó una sensibilidad del 75% y una especificidad del 87%, mientras que los índices compuestos no fueron discriminativos. El recuento de leucocitos se correlacionó solo moderadamente con la duración de la isquemia, lo que indica información no explicada por completo por el tiempo transcurrido. La disfunción eréctil pospriapismo, un resultado secundario, se relacionó únicamente con la edad avanzada. Conclusiones: En el priapismo isquémico agudo, una mayor duración de la isquemia y un recuento leucocitario temprano más alto en la presentación identifican a los pacientes que fracasan con el tratamiento conservador y requieren derivación quirúrgica urgente, mientras que los índices inflamatorios compuestos no lo hacen; estos parámetros sencillos e inmediatamente disponibles pueden apoyar la estratificación temprana del riesgo y merecen validación en estudios multicéntricos más amplios.

Priapism; Leukocytes; Inflammation; Ischemia; Erectile dysfunction; Emergencies; Surgery

Palabras Clave
Priapismo; Leucocitos; Inflamación; Isquemia; Disfunción eréctil; Urgencias; Cirugía

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