How I treat priapism

Anele, Uzoma A.; Le, Brian; Resar, Linda M.S.; Burnett, Arthur L.

doi:10.1182/blood-2014-09-551887

Cited by 55 publications

(55 citation statements)

References 113 publications

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“…Priapism, an unwanted erection lasting 4 h or more, occurs in 20% of men with HbSC and is a clinical emergency (Lionnet et al , ). Priapism often occurs as young men reach sexual maturity (Adeyoju et al , ), and may be the presenting sign of HbSC disease in previously undiagnosed men (Anele et al , ). Typically caused by acute ischaemic injury, priapism may be continuous, intermittent or recurrent (stuttering priapism).…”

Section: Systemic Complicationsmentioning

confidence: 99%

Knowledge insufficient: the management of haemoglobin SC disease

2016

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Although haemoglobin SC (HbSC) accounts for 30% of sickle cell disease (SCD) in the United States and United Kingdom, evidence-based guidelines for genotype specific management are lacking. The unique pathology of HbSC disease is complex, characterized by erythrocyte dehydration, intracellular sickling and increased blood viscosity. The evaluation and treatment of patients with HbSC is largely inferred from studies of SCD consisting mostly of haemoglobin SS (HbSS) patients. These studies are underpowered to allow definitive conclusions about HbSC. We review the pathophysiology of HbSC disease, including known and potential differences between HbSS and HbSC, and highlight knowledge gaps in HbSC disease management. Clinical and translational research is needed to develop targeted treatments and to validate management recommendations for efficacy, safety and impact on quality of life for people with HbSC.

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Section: Systemic Complicationsmentioning

confidence: 99%

Knowledge insufficient: the management of haemoglobin SC disease

2016

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“…Studies that focus on the development of new preventive therapies are of great clinical relevance. Alterations of the nitric oxide (NO)-cGMP-phosphodiesterase-5 (PDE5) signaling pathway have been implicated as a major mechanism for priapism in SCD, which is not simply a consequence of vascular blockage (Kato, 2012;Anele et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Beneficial Effect of the Nitric Oxide Donor Compound 3-(1,3-Dioxoisoindolin-2-yl)Benzyl Nitrate on Dysregulated Phosphodiesterase 5, NADPH Oxidase, and Nitrosative Stress in the Sickle Cell Mouse Penis: Implication for Priapism Treatment

Silva

Karakus

Musicki

et al. 2016

J Pharmacol Exp Ther

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Patients with sickle cell disease (SCD) display priapism, and dysregulated nitric oxide (NO) pathway may contribute to this condition. However, current therapies offered for the prevention of priapism in SCD are few. The 3-(1,3-dioxoisoindolin-2-yl)benzyl nitrate (compound 4C) was synthesized through molecular hybridization of hydroxyurea and thalidomide, which displays an NO-donor property. This study aimed to evaluate the effects of compound 4C on functional and molecular alterations of erectile function in murine models that display low NO bioavailability, SCD transgenic mice, and endothelial NO synthase and neuronal NO synthase double gene-deficient (dNOS 2/ ) mice, focusing on the dysregulated NO-cGMP-phosphodiesterase type 5 (PDE5) pathway and oxidative stress in erectile tissue. Wild-type, SCD, and dNOS 2/2 mice were treated with compound 4C (100 mmol/kg/d, 3 weeks). Intracavernosal pressure in anesthetized mice was evaluated. Corpus cavernosum tissue was dissected free and mounted in organ baths. SCD and dNOS 2/2 mice displayed a priapism phenotype, which was reversed by compound 4C treatment. Increased corpus cavernosum relaxant responses to acetylcholine and electrical-field stimulation were reduced by 4C in SCD mice. Likewise, increased sodium nitroprusside-induced relaxant responses were reduced by 4C in cavernosal tissue from SCD and dNOS 2/2 mice. Compound 4C reversed PDE5 protein expression and reduced protein expressions of reactive oxygen species markers, NADPH oxidase subunit gp91 phox , and 3-nitrotyrosine in penises from SCD and dNOS 2/2 mice. In conclusion, 3-week therapy with the NO donor 4C reversed the priapism in murine models that display lower NO bioavailability. NO donor compounds may constitute an additional strategy to prevent priapism in SCD.

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“…In this condition, the mechanisms of erection are entirely normal, but there appears to be a lack of mechanisms which control the returning of the penis to its flaccid state. Therefore, prolonged uncontrolled erections are seen in priapism [ 21 ]. Histopathologic studies have shown that tissue damage is dependent on the duration of the erection and irreversible damage occurs after 6 h. [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between Response to PDE5 Inhibitors and Penile Duplex Doppler Ultrasound in Erectile Dysfunction

et al. 2018

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The relationship between the results of penile duplex Doppler ultrasound (PDDU) and response to vardenafil was investigated in patients diagnosed with erectile dysfunction (ED). Data from 148 patients with ED were analyzed retrospectively. Patients who did not respond to therapy were classified in to Group I (n = 32), those who responded partially were classified into Group II (n = 40), and complete responders were classified into Group III (n = 76). Age, comorbidities, and vascular and penile pathologies were compared among the three groups. While diabetes mellitus (DM) and dyslipidemia positivity adversely affected the response to treatment, the presence of hypertension (HT), Peyronie’s disease and priapism increased the therapeutic response to the treatment (p < 0.05). Arterial insufficiency was present in 20 (30.3%), 25 (37.9%) and 21 (31.8%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). Venous insufficiency was observed in three (14.3%) patients in Group I and in eight (85.7%) patients in Group III (p = 0.001). Arterial/venous insufficiency was seen in 9 (30%), 14 (46.7%) and 7 (23.3%) of the patients in Group I, Group II and Group III, respectively (p = 0.001). The response rate to treatment was highest in normal patients according to PDDU, followed by patients with venous insufficiency. In addition, it was found that DM decreased the response to treatment, whereas the response increased in cases with HT, priapism and Peyronie’s disease.

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How I treat priapism

Cited by 55 publications

References 113 publications

Knowledge insufficient: the management of haemoglobin SC disease

Knowledge insufficient: the management of haemoglobin SC disease

Beneficial Effect of the Nitric Oxide Donor Compound 3-(1,3-Dioxoisoindolin-2-yl)Benzyl Nitrate on Dysregulated Phosphodiesterase 5, NADPH Oxidase, and Nitrosative Stress in the Sickle Cell Mouse Penis: Implication for Priapism Treatment

Relationship between Response to PDE5 Inhibitors and Penile Duplex Doppler Ultrasound in Erectile Dysfunction

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