Prognostic factors and outcome of management of ischemic priapism in Zaria, Nigeria

Abstract

Objectives:The objective of this study was to determine the nuances of management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.Patients and Methods:We retrospectively studied the case notes of all patients managed for ischemic priapism in the Ahmadu Bello University Teaching Hospital, Zaria, over a period of 10 years (2006–2015). The data extracted included patients’ age, occupation, duration of painful penile erection, and previous episodes. Addition information including precipitating factors, hemoglobin genotype, treatment, and complications was also retrieved. Data obtained were analyzed using SPSS version 20.Results:The records of a total of forty patients managed for priapism over the period under review were retrieved. Thirty-three (82.5%) of these patients had an operative intervention. The mean age was 23.7 years with a range of 8–53 years. Sixty percent of patients were young adults in their third decade of life. The minimum duration of erection at presentation was 18 h and a maximum period of 10 days with a mean of 105.5 h (4 days). Thirty-three patients (82.5%) had sickle cell anemia (HbSS). Erectile dysfunction (ED) accounted for 60% of all forms of postpriapism complications. Five patients (12.5%) had residual tumescence from fibrosis, and three patients had recurrence outside the immediate postoperative period. Duration of symptoms before surgical intervention, SSA and previous episodes were the most important prognostic factors.Conclusion:Priapism is a disease of the young, mostly sickle cell anemic patients. Late presentation remains the norm in our environment, hence a higher incidence of ED. The distal penile shunt is an effective means of achieving detumescence even with failed conservative management. Favorable outcome is highly dependent on the duration of erection and early intervention.

Outcomes of low-flow priapism and role of integrated penile prosthesis management

“…In this series, we performed immediate intraoperative penile prosthesis placement in eight patients, Table 5 Factors affecting occurrence of late onset ED post-recovery of low-flow priapism There were no statistically significant factor that affected occurrence of ED on 5-year follow-up of recovered low-flow priapism three of whom previously failed distal percutaneous shunting and five of whom failed with open distal shunting to relieve priapism. Justification for this policy is that the insertion of a semi-rigid penile prosthesis after the occurrence of intracorporeal damage and severe cavernous fibrosis following prolonged intractable priapism or recurrent priapism is considered a formidable surgical challenge with a high incidence of complications [12,[20][21][22]. The most important intraoperative and postoperative complications in cases marked by immediate insertion of a penile prosthesis include urethral injury, erosion of the tunica albuginea, distal migration of the prosthesis through the distal corporoglanular shunt site, wound and/or penile skin infection and decreased penile length [23].…”

Spectrum of urological emergencies and surgical interventions in a single tertiary health center

“…Priapism remains an important urological emergency that requires prompt intervention in order to avert the dreaded sequelae of permanent erectile dysfunction [ 20 ]. It is described as persistent penile erection that continues for >4 h or is unrelated to sexual intercourse [ 21 ].…”

Treatment of Priapism Secondary to Drugs for Erectile Dysfunction

“…Current clinical guidelines recommend the use of etilefrine as a first line of treatment for patients with iatrogenic priapism [12]. There is very little evidence to support the use of local measures or exercise to treat this type of priapism, and it is limited to case reports and case series [5, 10, 17]; the majority of the studies focus on pharmacological and surgical treatment [18–21].…”