Ischemic priapism in South‑East Nigeria: Presentation, management challenges, and aftermath issues

Abstract

Context: Ischemic priapism is the more common variety of priapism and often presents late. Outcome is largely dependent on the duration of ischemia.
Aims: To determine the etiology, presentation, management, and outcome of ischemic priapism.
Settings and Design: Retrospective analysis of consecutive cases presenting to three hospitals offering specialist urological services in South‑East Nigeria from January 2000 to December 2010.
Patients and Methods: Fifteen patients were assessed for clinical data and outcome.
Statistical Analysis Used: The data were analyzed descriptively and inferentially using Statistical Package for Social Sciences (SPSS version 16, SPSS Inc., Chicago IL, USA) with P < 0.05.
Results: Mean age was 30.5 years (standard deviation [SD] =1.63), range: 14–79 years. Onset to presentation interval ranged from 6 h to 28 days. Eight patients (53.3%) had sickle cell disease (SCD). Four patients (26.7%) had unidentified causes. The 8 SCD patients had stuttering priapism on several occasions previously. Six patients (40%) had taken oral herbal medications as treatment prior to presentation. Initial resuscitative measures were intravenous hydration, aspiration, and irrigation with normal saline in 13 patients. Glanulo‑cavernous shunt (Al‑Ghorab) was performed in all the patients. Detumescence was immediate in 14 and delayed in 1 patient. Three patients had transient recurrence of tumescence, while one had to be reshunted. Erectile dysfunction (ED) occurred in 7 patients (46.7%). Occurrence of ED increased significantly in patients presenting 24 h after onset of symptoms ([P = 0.032] Fishers exact test). Mean duration of follow‑up was 21.9 weeks (SD = 4.1), range: 3–156 weeks.
Conclusions: Low flow priapism is common in our environment, and approximately half will occur in SCD patients who have had stuttering priapism previously. Timely diagnosis and treatment will reduce the probability of severe ED. In our experience, the Al‑Ghorab shunt provides rapid relief. Enlightenment is vital in reducing ischemia time. Emphasis on preventive measures in SCD patients is vital.

Key words: Ischemic priapism, low flow, nonischemic priapism, stuttering priapism