From: Systematic review of medicinal leech therapy in urology
Manuscript details | Patient details | Leech details | ||||||||||||
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Author(s), year, PMID | CARE score | Demographics | Indications | Treatment | Outcomes | Species | Post-treatment leech details | |||||||
Age Years or as noted | Sex | Country | reason for therapy | Prior treatment history | leech Therapy details | Hematology | Medications | Favorable outcome? | Infection following therapy? | Additional information | ||||
Mousa et al. 20227, 35263644 | 25 | 1 month | M | Canada | Penile replantation | Heparin soaked gauze over penile replant | Leeches were placed on penile glans a total of 4 times and allowed to feed until engorged POD 4–5 | Following therapy patient developed hypovolemic shock with hgb 6.7g/dL requiring IV crystalloid resuscitation and blood products | Tetanus immunoglobulin, fluconazole, cefazolin, ciprofloxacin | Yes | No | POD 9 ischemia of foreskin developed, however glans well perfused | Hirudo medicinalis | Not discussed |
Asgari et al. 201717, 28845411 | 19 | 26 | M | Iran | Priapism | No other treatment before or after leech therapy, No penile prosthesis insertion due to financial restraints | 2 leeches on each side of penile shaft until engorged, 1 hour break and repeated | Initial CBC and BMP, Anticoagulation panel followed during therapy | IV Ceftriaxone 1.5 grams, antihistamines 7 days | Yes | No | Priapism presented at 80 h. Cavernosal swelling decreased but present post-therapy day 2, resolved at 1 month | Hirudo medicinalis | Not discussed |
Wagenheim et al. 20159, 26433079 | 23 | 2 week | M | USA | Glans penis congestion after bladder exstrophy repair | No other treatment before or after for indication | 1 leech to glans every hour with willing detachment, therapy stopped after venous congestion improved after 24 h of treatment | Hgb and Hct monitored q6 h, blood transfusions given if Hct <30%, 4 transfusion given PRBC 15 cc\kg | Ceftazidime | Yes | No | Not discussed | Hirudo medicinalis | Placed in alcohol after and never reused |
Banihani et al. 201418, 24928459 | 21 | 1 week | M | USA | Penile replantation | 1/4 baby aspirin given daily in solution through NG to prevent platelet sludging but leech therapy first line for venous congestion | 1–2 leeches applied then willingly detached every 15min–1hr continuously through POD 3 and used for relief prn of glans/corporal engorgement for 1 week, 2 x sutures placed to leech sites bleeding refractory to pressure | Several blood, FFP, and platelet transfusions given throughout treatment to maintain INR < or equal to 1.5, Platelets 50k–100k | Cefazolin 50mg/kg/day and bacitracin ointment TID, then cefepime 50 mg/kg/day, then PO amoxicillin BID | Yes | No | The first case of penile replantation for complete penile amputation with arterial microvascular anastomosis and the use of postoperative leech therapy for venous congestion. | Not discussed | Placed in alcohol after and never reused |
Roche et al. 201219, 22399258 | 22 | 28 | M | Belgium | Penile replantation | Prophylactic low molecular weight heparin given before post-operative but prior to therapy | Leech therapy started post-operative day 1 every 6–8 h for 4 days | Not discussed | Not discussed | Yes | No | 3 days after leech therapy, moderate wound margin necrosis presented on ventral side of penis; POD 21- urethral fistula [suprapubic catheter Tx for 4 weeks]; normal functioning/sensation by 18 months | Not discussed | Not discussed |
Mineo et al. 200420, 15134999 | 23 | 32 | M | USA | Penile replantation | no prior treatment | 6 treatments of 3 leeches over 20 h, spontaneous detachment q3–4 h | Hematocrit monitored stable throughout | Cefazolin and bacitracin ointment | Yes | No | Edema resolved at day 10, necrosis req some debridement, non-microsurgical | Hirudo medicinalis | Not discussed |
Philip et al. 200321, 12656920 | 18 | (case series) 69, 70, 74 | M | UK | Penoscrotal edema | no prior treatment | Area cleaned with soap and water, placed and normally released after engorgement (15–40 min), puncture sites continued to drain the next 6–10 h. Repeated daily for 6, 11, and 15 days | Hgb monitored stable throughout no dec >5% | Not discussed | Yes | No | Primary benefit was drainage from puncture | Hirudo medicinalis | Not discussed |
Goessl et al. 199722, 9224347 | 20 | 56 | M | Germany | Scrotal hematoma | No prior treatment w/puncture or surgery due to diffuse tissue layer spread of hematoma | 12 days, 70 total leeches, 5–7 daily | No significant decrease in Hgb throughout treatment | Not discussed | Yes | No | 1.5L scrotal hematoma | Not discussed | Not discussed |
Pantuck et al. 19961, 8973688 | 23 | 37 | M | USA | Penile replantation | Post-operative aspirin but leech therapy first line for venous congestion | 1–2 leeches added daily to distal third until sated (20–45 min) no signs of venous congestion at 5 days and treatment stopped | 4 g/dL drop in Hgb but no transfusion required | IV antibiotics unspecified | Yes | No | Swelling improved, required debridement | Hirudo medicinalis | Discarded in 70% alcohol as medical waste |
Lafolla, 19955, 7595772 | 24 | 18 h | M | USA | Glans penis congestion after bladder extrophy repair with penile lengthening and pelvic osteotomy | Prior to leech therapy, venous engorgement by bilateral incisions after dilute injection of heparin to glans was unsuccessful | Leech therapy started post-operative day 2, 6 leeches over 5-h period, stored in physiologic saline, attachment facilitated by nick with 22-gauge needle. oozing of blood from sites occurred up to 24 h after therapy | Hematocrit 40% before and 26% after procedure. 10ml/kg pRBC given during procedure and again 10 mL/kg pRBC given after. 20ml/kg was given over 48 h after procedure, raising Hct to 38%. Normal coag studies prior, after PTT was 85 sec and corrected with post-op 10ml/kg FFP | Cefazolin and gentamicin given for 72 h after procedure | Yes | No | Failed initial tx bilateral incisions after injection of dilute heparin solution into glans penis; given total of 40 mg/kg packed RBCs to control Hg levels; given 10 mg/kg FFP due to increased PTT | Hirudo medicinalis | Engorged leeches were killed with immersion in isopropyl alcohol and discarded as biohazard waste |
Isgar and Turner, 198923, 2611633 | 16 | 81 | M | UK | Scrotal hematoma s/p bilateral hydroceles/epididymal cysts | Intraoperative 200 ml blood evacuated from scrotum, tissue remained tense | Applied to scrotum until engorged with blood (approx. 20 min), Process was repeated 6 days daily with 6 leeches per day | Not discussed | Not discussed | Yes | No | Not discussed | Not discussed | Leeches were placed in 6% solution for 2min, where blood was regurgitated, and placed in individual tanks containing rainwater. |