惡性陰莖異常勃起之臨床特徵與預後：系統性回顧

林李宜菁¹、謝宗頤²

國立臺灣大學醫學院附設醫院¹教學部，²泌尿部

Clinical Characteristics and Outcomes of Malignant Priapism:
A Systematic Review

Yi-Jing Lin Lee¹, Tsung-Yi Hsieh²

¹Department of Medical Education, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan

²Department of Urology, National Taiwan University Hospital, National Taiwan University, College of Medicine, Taipei, Taiwan

Purpose: Malignant priapism (MP) presents unique clinical challenges, often yielding suboptimal results with conventional acute interventions. Given the scarcity of large-scale studies and the uncertain prognosis associated with standard treatments, we conducted a systematic review to evaluate clinical characteristics, management outcomes, and prognostic variations across different underlying malignancies.

Materials and Methods: A comprehensive search of PubMed, Embase, and Scopus databases (1995–2025) was conducted using terms including “Penile metastasis,” “Penile metastases,” and “Malignant priapism.” Of 667 unique records screened, 63 studies met the inclusion criteria and were included in this review. Patient characteristics, clinical presentations, and management outcomes were analyzed.

Results: Data from 77 patients were analyzed (median age: 57.5 years; median priapism duration: 7 days). Solid tumors accounted for 71.4% of cases (83.6% metastatic; 16.4% primary penile cancer), while 28.6% were hematologic malignancies. Acute management included cavernosal aspiration/injection (62.3%), shunt procedures (35.1%), corporotomy (7.8%), and embolization (3.9%). Sustained detumescence was achieved in only 41.6% of patients overall, and 24.7% required penectomy. Compared to hematologic cases, solid tumor MP was associated with significantly longer duration (p < 0.001), lower rates of sustained detumescence (p < 0.001), and higher penectomy rates (p = 0.002).

Conclusion: Malignant priapism often shows limited response to standard interventions, particularly when secondary to solid tumors. Early identification of the underlying malignancy is crucial, as solid tumor etiology portends a poorer functional prognosis and a higher likelihood of surgical escalation compared to hematologic causes. Management should be tailored based on the specific oncological etiology.