Behzad Abbasi

Scherñuk J, et al. Investig Clin Urol. 2026 May;67(3):307-309. https://doi.org/10.4111/icu.20260111

This study aims to investigate intraoperative and 30-day postoperative outcomes in patients with do-not-resuscitate orders (DNR) undergoing urological surgery. Data from the American College of Surgeons National Surgical Quality Improvement Program (2005-2012) was used to identify urology patients with documented DNR orders. Controls were propensity score-matched based on sex, age, BMI, smoking status, functional status, ASA classification, surgery type, wound class, and comorbidities. We identified 245 DNR patients and 234 matched controls. Most DNR patients were male (75%), White (69%), hypertensive (75%), and underwent minor surgeries (57%). Baseline characteristics showed no significant differences between DNR and non-DNR cohorts. Compared to non-DNR, DNR patients had higher mortality rates (14% vs. 6%, p = 0.003), especially in minor surgeries (6.9% vs. 2.6%, p = 0.016), shorter time from operation to death (14 days, IQR 4-22 vs. 18 days, IQR 11-21, p = 0.4), longer median hospital stay (6 days, IQR 1-14 vs. 1 day, IQR 0-6, p < 0.001), and extended time to discharge (3 days, IQR 1-7 vs. 1 day, IQR 0-4; p < 0.001). DNR patients also had more minor postoperative complications (12% vs. 6%, p = 0.025), most notably urinary tract infections (10% vs. 4.3%, p = 0.013). DNR patients undergoing urological surgery face higher mortality, longer hospital stays, and more minor complications. Clinicians should weigh surgical benefits against increased mortality risk, considering the lower threshold for withdrawing life support and potential failure or delays in complication management.

We conducted a population-based analysis of Fournier's gangrene to compare risk factors and mortality with perineal cellulitis. We analyzed National Inpatient Sample data (2016-2020) to identify Fournier's gangrene and perineal cellulitis cases. Demographic, comorbidity, and procedural data were extracted. Logistic models assessed risk factors for Fournier's gangrene diagnosis and mortality. A total of 73,472 cellulitis and 9,326 Fournier's gangrene cases were identified corresponding to 74,905 (range 63,050-79,165) and 9,115 (range 7,925-11,080) median yearly weighted cases, respectively. Fournier's gangrene diagnosis vs cellulitis was positively associated with Native American race (OR 1.46, 95% CI 1.19-1.79), weekend (OR 1.12, 95% CI 1.06-1.18) or December (OR 1.33, 95% CI 1.22-1.44) admissions, diabetes mellitus (OR 2.51, 95% CI 2.38-2.64), and malignancy (OR 2.29, 95% CI 2.07-2.54). Conversely, Hispanic (OR 0.79, 95% CI 0.74-0.85), Asian/Pacific Islander races (OR 0.83, 95% CI 0.69-0.99), and the highest household income quartile (OR 0.84, 95% CI 0.78-0.90) were linked to a reduced likelihood of Fournier's gangrene diagnosis. Elevated mortality risks were observed with female gender (OR 1.33, 95% CI 1.08-1.63), Native American ethnicity (OR 2.29, 95% CI 1.14-4.57), and procedural frequency (OR 1.27, 95% CI 1.24-1.3) among Fournier's gangrene cases. Various patient and clinical factors are linked to the development and mortality of Fournier's gangrene compared to perineal cellulitis. Improved access to care and understanding of Fournier's gangrene can enhance patient outcomes.

To compare Fournier's gangrene in female and male patients, and identify mortality-associated characteristics in both. We employed National Inpatient Sample data (2016-2020) to identify Fournier's gangrene cases and extracted demographic, comorbidity, and procedural variables. Multivariable regression models were utilized to identify mortality risk factors for both cohorts. We identified 2875 females (31%) and 6451 males (69%) with Fournier's gangrene corresponding to an estimated 14,375 (95% CI 13,784-14,966) and 32,255 (95% CI 31,390-33,120) cases, respectively. Females were more likely to die than males (7.1% vs 5.7%, P < .0001, respectively). Median incidence rates were 1.7 (IQR 1.5-1.8) and 4 (IQR 3.6-4.3) cases per 100,000 person-years for females and males, respectively. Females had higher median age, longer hospital stays, more charges, procedures, and fecal diversion rates, but lower routine discharges than males (P < .05). Non-White females had increased mortality odds compared to White females (odds ratio [OR] 1.49, 95% CI 1.07-2.07, P = .019). Prolonged interval until initial perineal debridement correlated with higher mortality odds in both females and males (OR 1.02, 95% CI 1-1.04, P = .034 vs OR 1.03, 95% CI 1.01-1.05, P < .0001). Diabetes lowered mortality odds in females and males (OR 0.68, 95% CI 0.47-0.99, P = .046 vs OR 0.54, 95% CI 0.41-0.7, P < .0001). In females, Fournier's gangrene incidence surpasses previous reports, with slightly worse outcomes compared to males, emphasizing the need for precise clinical assessment and early intensive interventions.

Purpose: To explore the differences of priapism events among a diverse cohort taking erectogenic medicines (i.e., phosphodiesterase type 5 inhibitors [PDE5i] and intracavernousal drugs).Methods: We queried the World Health Organization global database of individual case safety reports (VigiBase) for records of the adverse drug reactions (ADR) with sildenafil, tadalafil, avanafil, vardenafil, papaverine, and alprostadil. Disproportionality analyses (case/non‐case approach) were performed to assess the reporting odds ratio (ROR) of priapism reporting in PDE5i consumers compared to intracavernousal drug recipients.Results: From a total of 133 819 ADR events for erectogenic medications, 632 were priapism (PDE5is: n = 550, 0.41%; intracavernousal drugs: n = 82, 9.92%). Priapism disproportionality signals from intracavernousal drugs were 25 times stronger than PDE5is (ROR = 34.7; confidence interval [CI] 95%: 27.12–43.94 vs. ROR = 1.38; 95% CI: 1.24–1.54). For all PDE5i agents, the 12–17 years age group had the highest ROR (9.49, 95% CI: 3.76–19.93) followed by 2–11 years (4.31, 95% CI: 1.57–9.4). Disproportionality signals for consumers under 18 for both all PDE5is as a whole (ROR = 4.57, 95% CI: 2.48–7.73) and sildenafil (ROR = 4.89, 95% CI: 2.51–8.62) were stronger than individuals 18 or older (ROR = 1.06, 95% CI: 0.93–1.21 and ROR = 1.08, 95% CI: 0.91–1.26, respectively).Conclusions: PDE5i use shows disproportionate priapism signals which are higher in young patients.

Background: Despite their efficacy and general safety, rare but devastating adverse drug reactions have been associated with phosphodiesterase type 5 inhibitors.Objectives: To determine the safety profile of oral phosphodiesterase type 5 inhibitors with a particular focus on priapism and malignant melanoma.Materials and methods: In this case–non‐case study, we queried the individual case safety reports for phosphodiesterase type 5 inhibitors within the World Health Organization global database of individual case safety reports (VigiBase) between 1983 and 2021. We included all individual case safety reports for sildenafil, tadalafil, vardenafil, and avanafil in men. For comparison, we also extracted the safety data from the Food and Drug Administration trials for these drugs. We assessed the safety profile of phosphodiesterase type 5 inhibitors by disproportionality analysis by measuring reporting odds ratio for their most commonly reported adverse drug reactions, once for all phosphodiesterase type 5 inhibitor reports and once for reports of oral phosphodiesterase type 5 inhibitor use in adult men (≥18 years old) with sexual dysfunction.Results: A total of 94,713 individual case safety reports for phosphodiesterase type 5 inhibitors were extracted. A total of 31,827 individual case safety reports were identified relating to adult men taking oral sildenafil, tadalafil, vardenafil, or avanafil for sexual dysfunction. The most common adverse drug reactions included poor drug efficacy (42.5%), headache (10.4% vs. 8.5%–27.6% [Food and Drug Administration]), abnormal vision (8.4% vs. ≤4.6% [Food and Drug Administration]), flushing (5.2% vs. 5.1%–16.5% [Food and Drug Administration]), and dyspepsia (4.2% vs. 3.4%–11.1% [Food and Drug Administration]). Priapism showed significant signals for sildenafil (reporting odds ratio = 13.81, 95% confidence interval: 11.75–16.24), tadalafil (reporting odds ratio = 14.54, 95% confidence interval: 11.56–18.06), and vardenafil (reporting odds ratio = 14.12, 95% confidence interval: 8.36–22.35). Comparing with other medications in VigiBase, sildenafil (reporting odds ratio = 8.73, 95% confidence interval: 7.63–9.99) and tadalafil (reporting odds ratio = 4.25, 95% confidence interval: 3.19–5.55) had significantly higher reporting odds ratios for malignant melanoma.Conclusion: Phosphodiesterase type 5 inhibitors show significant signals correlating with priapism among a large international cohort. Further clinical study is needed to elucidate whether this is from proper or inappropriate use or other confounding conditions, as analysis of pharmacovigilance data does not allow for quantifying the clinical risk. Also, there appears to be a relationship between phosphodiesterase type 5 inhibitor use and malignant melanoma, which warrants additional study to better understand causation.