Sildenafil relieves priapism in patients with sickle cell disease

Bialecki, Eldad S.; Bridges, Kenneth R.

doi:10.1016/s0002-9343(02)01165-8

Cited by 54 publications

(43 citation statements)

References 10 publications

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“…He came to us during the major attack that lasted 6 hr. He underwent sedation, hydration, and sildenafil treatment [38] without success. He was then submitted to exchange transfusion and cavernosa aspiration followed by irrigation with saline and adrenaline, which was performed 12 hr after the beginning of the symptoms.…”

Section: Resultsmentioning

confidence: 99%

Follow‐up of sickle cell disease patients with priapism treated by hydroxyurea

Saad¹,

Lajolo²,

Gilli³

et al. 2004

American J Hematol

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Hydroxyurea is one of the most successfully used therapies for sickle cell disease. Results of many clinical trials point to hydroxyurea administration for patients with frequent painful crises and acute chest syndrome. Priapism is one of the complications that could be prevented by hydroxyurea, but there are few reports demonstrating the results. Since November 1993, hydroxyurea has been used in our clinic for preventing priapism in patients with stuttering or major attacks who are still capable of achieving intercourse on demand. Five patients were enrolled in the study, and 4 cases benefited by this treatment. After the initial treatment for the acute attack, all five patients developed stuttering priapism. Hydroxyurea was then introduced at the initial dose of 10 mg/kg, and as the hydroxyurea dosage increased, the number or length of priapism episodes decreased. One to two months after the maximal dose (20-35 mg/kg) was introduced, the episodes disappeared. In two patients, we were forced to administer over 30 mg hydroxyurea/kg to abort the episodes, and, in another patient, 25 mg/kg was necessary. All patients present normal sexual activity. Hydroxyurea was discontinued in two patients, but stuttering priapism reappeared. Hydroxyurea was then re-introduced, and priapism disappeared. One patient, using 20 mg hydroxyurea/kg, had a 6-year remission of priapism after hydroxyurea administration; however, he experienced stuttering priapism, 1 month before a major attack, that progressed to impotence. During that month, he did not seek medical attention. In conclusion, the data here presented suggests that hydroxyurea may prevent priapism attacks in sickle cell disease, probably at higher doses than usually prescribed for painful crisis prevention. Am.

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Section: Resultsmentioning

confidence: 99%

Follow‐up of sickle cell disease patients with priapism treated by hydroxyurea

Saad¹,

Lajolo²,

Gilli³

et al. 2004

American J Hematol

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“…In patients with sickle cell disease, sildenafil has been reported to cause a low-flow priapism yet has also successfully treated priapism due to vasoocclusive crisis (6,7). Decreased expression of PDE 5 in sickle cell patients may be a contributor of stuttering priapism (characterized by repeated erections that are usually reversible but painful) (4) and could theoretically be potentiated by sildenafil.…”

Section: Discussionmentioning

confidence: 99%

Sildenafil citrate ingestion and prolonged priapism and tachycardia in a pediatric patient

Wills

Albinson

Wahl

et al. 2007

Clinical Toxicology

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Introduction.Little is known about the toxicity of sildenafil overdose in the pediatric population. We present a case of prolonged priapism and tachycardia due to unintentional sildenafil overdose in a child. Case report. A 19-month-old male ingested up to six 50 mg Viagra tablets 45 minutes prior to presentation at the emergency department. Initial vital signs included temperature 98.2 o F, blood pressure 90/58 mmHg, heart rate 140, respirations 20, and oxygen saturation of 100% on room air. The child weighed 10.4 kg. Physical exam revealed a happy, smiling, laughing toddler who was cooperative with all aspects of his exam. He had mild facial flushing and an erect penis which was normal in color and had a capillary refill of two seconds. Precordial palpation did not show evidence of increase dynamic force, his heart sounds were regular, and no ectopy was noted. His peripheral pulses were strong and regular in all four extremities. No gastrointestinal decontamination was performed. The patient was started on maintenance IV fluids and admitted to the pediatric floor for observation. The patient had a non-painful tumescent penis and mild tachycardia for about 24 hours post-ingestion. The child never had pain from the constant erection. Sildenafil concentration drawn approximately seven hours after ingestion was 3900 ng/ml (reporting limit 24 ng/ml) and N-desmethylsildenafil level was 1700 ng/ml (reporting limit 24 ng/ml). Conclusion. This case of pediatric sildenafil ingestion (up to 30mg/kg) initially resulted in facial flushing and priapism. The child had asymptomatic tachycardia and prolonged priapism that persisted until hospital discharge approximately 24 hours after ingestion. The erection was non-painful and required no urologic intervention, most likely representing a high flow state. In this ingestion, only supportive care was required.

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“…It is here that PDE5 inhibitors offer promising new treatment possibilities for the prevention of stuttering priapism in this patient population. 22,[65][66][67][68] Consequently, multicenter, randomized, placebo-controlled trials are under way to further evaluate the potential use and benefit of PDE5 inhibitors for the treatment of stuttering priapism.…”

Section: Hormonal Therapymentioning

confidence: 99%

“…25 An emerging and successful new therapy is the use of PDE5 inhibitors for the preventative treatment of stuttering episodes. 4,[64][65][66][67][68] PDE5 inhibitors may be used initially or in conjunction with concomitant administration of intracavernosal phenylephrine injections to treat acute episodes of priapism before PDE5 inhibitor therapy has taken full effect. Research is encouraging in this avenue and suggests PDE5 inhibitors as useful preventative therapy for mild-to-moderate cases of stuttering priapism with minimal side effects, commonly seen with other systemic therapies.…”

Section: Perspectivesmentioning

confidence: 99%

“…PDE5 inhibitor therapy is the first pharmacotherapy which targets the true molecular biology of priapism. 22,23,[64][65][66][67][68] While premature in its efforts to translate bench science to the clinic, novel discoveries in basic science research delving into opiorphins and adenosine as signaling pathways that may play a role in the development of stuttering ischemic priapism, represent exciting potential targets for future therapies directed at the prevention and thus treatment of priapism. 73,74 While further research is needed to evaluate the safety and efficacy of systemic therapies for the prevention of stuttering ischemic priapism, a greater understanding of the pathophysiology involved in the mechanisms behind SCDassociated priapism, will continue to pave the way for novel emerging therapies to be developed focusing on prevention as the goal.…”

Section: Perspectivesmentioning

confidence: 99%

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Medical management of ischemic stuttering priapism: a contemporary review of the literature

Levey¹,

Kutlu²,

Bivalacqua³

2011

Asian J Androl

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Priapism is defined as a prolonged and persistent erection of the penis without sexual stimulation. This is a poorly understood disease process with little information on the pathophysiology of this erectile disorder. Complications from this disorder are devastating due to the irreversible erectile damage and resultant erectile dysfunction (ED). Stuttering priapism, though relatively rare, affects a high prevalence of men with sickle-cell disease (SCD) and presents a challenging problem with guidelines for treatment lacking or resulting in permanent ED. The mechanisms involved in the development of priapism in this cohort are poorly characterized; therefore, medical management of priapism represents a therapeutic challenge to urologists. Additional research is warranted, so we can effectively target treatments for these patients with prevention as the goal. This review gives an introduction to stuttering priapism and its clinical significance, specifically with regards to the patient with SCD. Additionally, the proposed mechanisms behind its pathophysiology and a summary of the current and future targets for medical management are discussed.

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Sildenafil relieves priapism in patients with sickle cell disease

Cited by 54 publications

References 10 publications

Follow‐up of sickle cell disease patients with priapism treated by hydroxyurea

Follow‐up of sickle cell disease patients with priapism treated by hydroxyurea

Sildenafil citrate ingestion and prolonged priapism and tachycardia in a pediatric patient

Medical management of ischemic stuttering priapism: a contemporary review of the literature

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