Ischemic Priapism: Evaluation in a Third-Level Hospital in Mexico

39% of priapism patients developed ED at 30 days — most arrived with erections lasting over 24 hours

Journal: Revista Médica del Instituto Mexicano del Seguro Social | Published: 2026-06-01 | Type: Cross-sectional, single-center | PMID: 42241395 Authors: Sánchez-Villaseñor G et al. (IMSS Centro Médico Nacional de Occidente, Guadalajara, Mexico) Funding/COI: Funding not disclosed. Authors declared no conflicts of interest via ICMJE form.

Summary

Twenty men presenting with ischemic priapism at a Mexican tertiary care center had a median symptom duration of 31.8 hours before seeking treatment — far beyond the window in which permanent damage is typically avoidable. Most had been taking antihypertensive medications. Seven of 18 patients who underwent surgical management developed erectile dysfunction within 30 days. The authors conclude that delayed presentation, driven by low health literacy and socioeconomic factors, explains the high complication rate.

Claims

• 20 patients included, ages 25–78 (median 32.5 years), symptom duration 10–120 hours (median 31.8 hours)
• Medications reported: losartan 40%, metoprolol 30%, nifedipine 15%, hydralazine 15%, furosemide 15%, prazosin 5%, tamsulosin 5%, anxiolytics/antidepressants (clonazepam, fluoxetine, escitalopram, risperidone) 20%
• Comorbidities: hypertension 50%, type 2 diabetes 15%, dyslipidemia 5%
• Substance use: smoking 60%, alcohol 50%, methamphetamine 15%
• Initial management: aspiration/drainage of corpora cavernosa in 90% (18/20); of those, 83% required saline irrigation, 80% of remaining required intracavernosal epinephrine
• Escalation required: 45% (9/20) needed surgical shunting within 24 hours; procedures included Winter, Ebbehoj, Burnett, and Al-Ghorab corporoglandular shunts; 2 patients required saphenous-cavernous bypass
• 30-day complications: ED 38.8% (7/18), penile hematoma 15%, urethral trauma 10%, penile abscess 5%

Study Quality

This is a cross-sectional descriptive study with a sample of 20 patients and one month of follow-up. That combination makes it essentially a case series with basic statistics — adequate for describing what arrived at one hospital, useless for establishing causation or generalizing outcomes. The study documents clinical management and short-term complications, which it does reasonably well given the constraints: the full Spanish-language results section provides specific drug names and procedural escalation steps that the English abstract omits.

The one-month follow-up for ED is particularly problematic. ED after ischemic priapism can persist, resolve, or worsen over 6–12 months as penile fibrosis evolves. Reporting 38.8% at 30 days is an early snapshot, not an outcome.

Red Flags

• N=20 from a single center — no statistical power for any comparative claim
• One-month follow-up is too short for meaningful ED outcome data
• The English abstract contains a transcription error: "1 (50%) dyslipidemia" should be "1 (5%)" per the Spanish text
• Denominator inconsistency: "7 (38.8%) of the patients" — 7/20 = 35%, but 7/18 = 38.9%, suggesting the denominator is the surgical subgroup, not all 20
• No control group, no comparison cohort, no multivariable analysis
• Funding not disclosed despite institutional affiliation with a government health system (IMSS)
• Selection bias: tertiary referral center captures severe or delayed cases, not typical presentations
• The claim that antihypertensives caused the priapism is asserted, not analyzed — 40% were on losartan but no drug-level analysis is performed

Strengths

• One of few published series on priapism management from a Latin American tertiary center, where presentation patterns and comorbidities differ from North American or European cohorts
• The Spanish-language results section provides unusually detailed drug-level data (specific agents named, not just drug classes)
• Step-by-step documentation of escalating surgical management is clinically informative, even if not analyzable at N=20
• Honest about the social determinants driving late presentation (education level, socioeconomic status, embarrassment)

Verdict

This paper is a 20-patient descriptive series — modest scope, short follow-up, and no comparison group. It doesn't advance the evidence base for priapism management. What it does offer is a granular snapshot of a referral center's real-world case mix: who showed up, what drugs they were on, how long they waited, and how quickly things went wrong. The detailed medication list and surgical escalation protocol have niche clinical value. The 38.8% ED rate at 30 days is alarming but uninterpretable without longer follow-up. Read it as a local epidemiological report, not as evidence.