Risk factors, diagnosis, and long-term erectile dysfunction outcomes in priapism: a retrospective analysis of 186 cases from a single institution

A retrospective analysis of 186 priapism cases between 2015-2024 was conducted using ICD-10 codes (N48.3) in a single high-volume institution. Data on age, race, insurance status, priapism subtype, etiology, and treatment outcomes were collected. The median age at presentation was 50.5 years (IQR: 39.3-60.0), with most patients being White (60.2%). Black and Asian patients tended to present at younger ages than White patients (45 and 38 vs. 55.5 years, p < 0.05). Black patients had longer priapism durations than White patients (36 vs. 7.8 h, p < 0.001). Commercial insurance was most common (60.2%), but those with Medi-Cal/Medicaid or self-pay had longer episodes compared to commercial payers (25 and 39 vs. 7 h, respectively, p < 0.05). Acute ischemic priapism was the most common subtype (63.4%), with intracavernosal injection therapy (54.8%) as the leading cause followed by medications such as Trazodone. Multivariate analysis revealed that ischemic priapism duration was the strongest predictor of de novo ED, with episodes lasting more than 36 h significantly increasing the risk (OR = 61.3, p < 0.001), although episodes over 20 h were also found to increase the risk (OR = 25.2, p = 0.007). These results emphasize the importance of early intervention and addressing health disparities to reduce long-term complications.