Le priapisme : diagnostic et prise en charge

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

“…This medical treatment is poorly used by several authors [5] [8] [10] [12]. Our attitude is in line with that of Carniceli and Akakpo [11] who state that in the case of priapism in a sickle cell patient, local treatment of the priapism will be associated with general measures including hydration and intravenous analgesics, oxygen therapy and possibly plasma exchanges. 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.…”

“…This could be explained by the multidisciplinary collaboration (paediatrics-haematology-urology) in the management of sickle cell disease and its complications. However, this consultation period is still long and improving it requires education and awareness raising actions for patients and their families as well as for health personnel, because according to Carnicelli and Akakpo [11], this is an emergency treatment whose aim is to prevent irreversible erectile dysfunction. The duration of the priapism and the delay in treatment are predictive factors for the recovery of erectile function.…”

“…The duration of the priapism and the delay in treatment are predictive factors for the recovery of erectile function. Histological changes are observed as early as the 12th hour and, in extreme cases, a necrosis of the smooth muscle after 48 hours [11].…”

“…Sickle-cell anaemia is a frequent cause of priapism with more than a third of patients (homozygous SS) presenting at least one episode of priapism [11]. The mechanisms causing priapism in this group of patients are varied and incompletely elucidated, but are probably linked to a lack of regulation of nitric oxide (NO) and phosphodiesterase type 5 enzyme activity [11].…”

“…Doppler ultrasound of the penis and the perineum is also performed in case of arterial priapism in order to highlight the site of the fistula. Finally, magnetic resonance imaging of the penis, which is not routinely required, can be discussed for predictive purposes to assess muscle viability [11]. In our series, the diagnosis was clinical because the majority of patients were known to have sickle cell disease.…”