Priapisme aigu drépanocytaire: analyse de 20 cas traités au CHU de Brazzaville

Abstract

Objectif : Évaluer les résultats des traitements médicaux et chirurgicaux du priapisme drépanocytaire. Malades et méthodes : Vingt malades ont été traités pour priapisme drépanocytaire dans les services d'urologieandrologie et d'hématologie du CHU de Brazzaville, du 1 er janvier 1995 au 31 décembre 2005. Les méthodes thérapeutiques ont été les injections intracaverneuses d'étiléfrine et les fistules cavernospongieuses. Résultats : 1) Cinq patients traités sans succès par transfusion et étiléfrine orale ont été secondairement traités avec succès par la technique de Winter ; 2) sur cinq patients traités par injection intracaverneuse d'étiléfrine en première intention, on note trois succès et deux échecs, traités avec succès par la technique de Winter ; 3) sur dix patients traités par fistules cavernospongieuses selon Winter en première intention, trois ont récidivé et ont été secondairement traités avec succès par la méthode d'Al-Ghorab. Les résultats fonctionnels à long terme sont : 25 % d'absence d'érection, 25 % d'insuffisance d'érection et 50 % d'érection normale. Conclusion : Le traitement par injection intracaverneuse d'étiléfrine est efficace avant la 24 e heure. Au-delà, les fistules cavernospongieuses donnent les meilleurs résultats. Pour citer cette revue : Andrologie 21 (2011). Mots clés Priapisme · Drépanocytose · Étiléfrine · Fistule cavernospongieuseAbstract Objective: To evaluate the results of medical and surgical treatment of sickle cell priapism.Patients and methods: Between 01 January, 1995 and 31 December, 2005, 20 patients were treated for priapism in the services of Urology-Andrology and Haematology of the University Hospital, Brazzaville. Treatment included intracavernous injection of etilefrine and cavernospongious fistula. Results: 1) Five patients initially treated with transfusion and oral etilefrine without success were successfully cured after using the technique of Winter. 2) In 5 patients treated with intracavernous injection of etilefrine as first-line, 3 were cured and two failed, who were later cured using the technique of Winter. 3) Of 10 patients treated by Winter cavernospongious fistulas as first-line, 3 had recurrences and secondarily were successfully treated by the method of Al-Ghorab. Functional results in the long term include 25% lack of erection, 25% of erection failure and 50% of normal erection. Conclusion: Treatment with intracavernous injection of etilefrine is effective before the 24th hour. Beyond this time, cavernospongious fistula yield better results. To cite this journal: Andrologie 21 (2011).

Management of Priapism in Sickle Cell Patients: Experience of the Urology Department of the University Hospital Centre of Libreville

“…We have a fairly large number of cases over a short study period in a relatively young population. These results are the same on those of Moby Mpah et al [5] in Cameroon, who report 33 cases of priapism, 19 of which were in sickle cell patients over a period of 36 months. In a prospective study conducted over 7 months in Congo, Okoko et al [6] reported a larger sample of 68 cases of priapism in sickle cell patients, but in 79.4% of cases it was intermittent priapism which did not require hospital care.…”

“…In 16 cases (84.2%) a puncture of the corpus cavernosum and/or a distal cavernosal-spongiosum shunt according to Al Ghorab in 6 cases were associated with the treatment. Corpus cavernosum puncture is widely practised by Kassogue et al [4] in Mali, Moby Mpah et al [5] in Cameroon and Fall et al [10] in Senegal in 89%, 67.9% and 52.4% of cases respectively. However, several series [3] [8] [12] reveal that surgical management was necessary in the majority of cases.…”

“…In the event of failure, of recurrence, or immediately in the event of suspicion of anoxia (pain, delay greater than 24 hours), the gas measurement of the cavernous blood is indicated to assess the intensity of the anoxic suffering and indicate the time of surgery [2]. Several authors [3] [4] [5] report the use of these drugs with varying results.…”

Sexual Functional Prognosis of Penile Emergencies at the University Hospital of Libreville

“…These results are similar to Kouamé et al [1], with 80% of patients maintaining a normal erection and good sexual function. Bouya et al [8] in Congo Brazzaville, Habou et al [15] in Niger, and Kassogué et al [11] in Mali found a lower result with respectively 50%, 58.3%, and 31% of patients having a normal erectile function. Falandry et al [12] report more alarming results with 56.8% of a total loss of erectile function.…”

“…The longer the delay, the higher the risk of permanent sexual dysfunction, since 66.7% of their patients treated within the first 72 hours recovered a normal erection, whereas only 25% of patients treated after this delay had a favorable evolution. Bouya et al [8] report that all ten patients with absent or insufficient erection were treated after the 30 th hour and that among the five patients treated with intracavernous injection of etilefrine, all three successes were observed in patients seen before the 24 th hour. Kamel et al [13] consider that the risk of secondary erectile dysfunction depends on several factors: the delay in treatment.…”