Finasteride for recurrent priapism in children and adolescents: a report on 5 cases

Barroso, Ubirajara; Marques, Thamy Cristine Santana; Novaes, Hugo

doi:10.1590/s1677-55382012000500014

Cited by 11 publications

(4 citation statements)

References 15 publications

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“…Barroso et al. also found that finasteride decreased the frequency and severity of priapic episodes in five children and adolescents with recurrent priapism [50]. In these studies, positive effects were noted using doses ranging from 1 to 5 mg daily.…”

Section: Finasteridementioning

confidence: 88%

Management of Recurrent Ischemic Priapism 2014: A Complex Condition with Devastating Consequences

Hoeh

Levine

2015

Sexual Medicine Reviews

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Section: Finasteridementioning

confidence: 88%

Management of Recurrent Ischemic Priapism 2014: A Complex Condition with Devastating Consequences

Hoeh

Levine

2015

Sexual Medicine Reviews

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“…Barroso et al. also found that finasteride can decrease the frequency and severity of priapic episodes in children and adolescents with recurrent priapism [23]. Advantages of this therapy include the potential for fewer side effects, with disadvantages being that recurrent priapic episodes are not uncommon in a substantial number of men, especially within the first few months after initiating therapy.…”

Section: Discussionmentioning

confidence: 99%

Prevention of Recurrent Ischemic Priapism with Ketoconazole: Evolution of a Treatment Protocol and Patient Outcomes

Hoeh

Levine

2014

The Journal of Sexual Medicine

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Introduction The management of recurrent ischemic priapism (RIP) is not clearly defined. Ketoconazole (KTZ) is used to treat RIP and produces a temporary hypogonadal state to suppress sleep-related erections (SREs), which often evolve into episodes of ischemic priapism in this population. Aim We review our experience to prevent RIP using KTZ and present our outcomes using a decreased dose regimen. Methods A retrospective chart review and phone survey of 17 patients with RIP was performed. KTZ inhibits adrenal and gonadal testosterone production with a half-life of 8 hours. By suppressing testosterone levels, SREs are interrupted. We compared our previous protocol of three times daily (TID) KTZ dosing with prednisone for 6 months with our current regimen of initiating KTZ 200 mg TID with prednisone 5 mg daily for 2 weeks and then tapering to KTZ 200 mg nightly for 6 months. Main Outcome Measures The primary outcome was the prevention of RIP using KTZ. Secondary outcomes included side effects secondary to KTZ use and patient satisfaction. Results All men experienced daily or almost daily episodes of prolonged, painful erections prior to starting KTZ. The mean number of emergency room (ER) visits per patient prior to starting KTZ was 6.5. No patient required an ER visit for RIP while on KTZ. Sixteen of 17 patients (94%) had complete resolution of priapism while on KTZ with effects noted immediately after starting therapy and no reported sexual side effects attributed to KTZ. One man stopped therapy after 4 days because of nausea/vomiting. Fourteen of 16 men eventually discontinued KTZ after a median duration of 7 months. Twenty-nine percent reported no recurrent priapic episodes after discontinuing. A total of 78.6% had partial or complete resolution of symptoms persisting after KTZ was discontinued with a mean post-treatment follow-up of 36.7 months. Conclusion No reliable effective preventative therapy has been identified for RIP. In our relatively sizable single-center experience, KTZ appears to be a reasonably effective, safe, and inexpensive treatment to prevent RIP while preserving sexual function. We now recommend our tapered dose regimen listed above. After 6 months, we recommend stopping the medication as we have found a majority of patients will not need to resume nightly KTZ.

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“…16,32 These drugs pos si bly counter the andro gen effect on penile tis sue, reduce noc tur nal tumes cence, and inhibit tes tos ter one medi ated NO release from the nerve ter mi nals. 33,34…”

Section: Secondary Priapism Pre Ven Tion Is the Key To Reduc Ing Pain...mentioning

confidence: 99%

Epidemiology and treatment of priapism in sickle cell disease

2022

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Ischemic priapism is a common but underrecognized morbidity affecting about 33% of adult men with sickle cell disease (SCD). The onset of priapism occurs in the prepubertal period and tends to be recurrent with increasing age. Significantly, priapism is associated with an unrecognized high burden of mental duress and sexual dysfunctions. The diagnosis of priapism is clinical. Many episodes of priapism will resolve spontaneously, but when an episode lasts longer than 4 hours, the episode is considered a urologic emergency requiring quick intervention with either corporal aspiration or shunt surgery. Only 3 randomized clinical trials (stilbesterol, ephedrine or etilefrine, and sildenafil) have been conducted for secondary priapism prevention in SCD. All 3 trials were limited with small sample sizes, selection biases, and inconclusive results after completion. The current molecular understanding of the pathobiology of priapism suggests a relative nitric oxide (NO) deficiency secondary to chronic hemolysis in SCD and associated phosphodiesterase type 5 dysregulation. We posit an increase in NO levels will restore the normal homeostatic relationship between voluntary erection and detumescence. Currently, 2 randomized phase 2 trials (1 double-blind, placebo-controlled trial and 1 open-label, single-arm intervention) are being conducted for secondary priapism prevention in men at high risk for recurrent priapism (NCT03938454 and NCT05142254). We review the epidemiology and pathobiology of priapism, along with mechanistic therapeutic approaches for secondary prevention of priapism in SCD.

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Finasteride for recurrent priapism in children and adolescents: a report on 5 cases

Abstract: ARTICLE INFO _______________________________________ _

Cited by 11 publications

References 15 publications

Management of Recurrent Ischemic Priapism 2014: A Complex Condition with Devastating Consequences

Management of Recurrent Ischemic Priapism 2014: A Complex Condition with Devastating Consequences

Prevention of Recurrent Ischemic Priapism with Ketoconazole: Evolution of a Treatment Protocol and Patient Outcomes

Epidemiology and treatment of priapism in sickle cell disease

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Finasteride for recurrent priapism in children and adolescents: a report on 5 cases

Abstract: ARTICLE INFO _________________________________________________________ ___________________

Cited by 11 publications

References 15 publications

Management of Recurrent Ischemic Priapism 2014: A Complex Condition with Devastating Consequences

Management of Recurrent Ischemic Priapism 2014: A Complex Condition with Devastating Consequences

Prevention of Recurrent Ischemic Priapism with Ketoconazole: Evolution of a Treatment Protocol and Patient Outcomes

Epidemiology and treatment of priapism in sickle cell disease

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Product

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Abstract: ARTICLE INFO _______________________________________ _