Abstract
Background: Priapism is defined as a prolonged and painful erection that persists beyond or is unrelated to sexual stimulation. Its frequency is high in sickle cell patients in our regions. Despite being a urological emergency, many patients are diagnosed at a late stage, increasing their risk of sequelae. In this article, we assessed the management of priapism in our department, with the aim of improving our daily clinical practices. Patients and Methods: We conducted a monocentric retrospective descriptive study from January 2005 to December 2020. All patients admitted and treated for priapism in our emergency department during the study period were included. The following variables were considered: age, sex, etiology, consultation delay, treatment type and outcomes. A follow-up visit was scheduled once at 1, 6 and 12 months post-treatment and the erectile function was evaluated during this visit. Results: In total 97 patients were treated during the study period. Priapism represented the 4th urological emergency after urinary retention, renal colic and hematuria. The mean age was 23.63 ± 11.5 years old. Sickle cell disease was observed in 59.8% of patients. Sixteen patients (16.50%) who consulted within 12 hours of priapism onset were successfully treated by oral or injectable etilefrine. Forty-three patients (44.33%) who consulted between 12 and 36 hours were successfully treated using distal spongio-cavernous fistula. After treatment, detumescence was obtained in 86 patients (88.66%). Eleven patients (11.34%), who consulted after the 36th hour, developed cavernous fibrosis with subsequent erectile dysfunction. Conclusion: Priapism represents the 4th cause of admission at our emergency department. Sickle cell disease was the main cause of ischemic priapism in our context. One patient in 2 consulted after 36 hours following the onset of symptoms. Medical treatment was effective in patients who consulted before 12 hours, while surgical treatment resulted in good outcomes in most of the patients who consulted after 36 hours.
Highlights
Priapism is defined as a persistent and painful erection for more than 4 hours, occurring without sexual stimulation [1]
Sickle cell disease was the main cause of ischemic priapism in our context
Ischemic priapism requires urgent treatment to prevent the occurrence of fibrosis and subsequent erectile dysfunction [5]
Summary
Priapism is defined as a persistent and painful erection for more than 4 hours, occurring without sexual stimulation [1]. Priapism is one of the most common emergencies managed by urologists [2] [3]. Pathophysiological mechanism distinguishes 2 types of priapism: ischemic and non-ischemic priapism [1] [4]. Non-ischemic priapism is rare and mainly associated with perineal trauma. Commonly considered as low flow priapism, is the most frequent, often idiopathic, but usually related to sickle cell disease [1]. Ischemic priapism requires urgent treatment to prevent the occurrence of fibrosis and subsequent erectile dysfunction [5]. Patients with sickle cell disease have shown limited knowledge of this urological emergency, often leading to delayed consultation [6]. We assessed the management of priapism in our department, with the aim of improving our daily clinical practices
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