Priapism prevention

Pseudoephedrine dosed at 30 to 60 mg/day taken at bedtime has been used to prevent or decrease the number of episodes of priapism.6 Terbutaline 5 mg has been used orally to prevent priapism with mixed results.38,39 Leuprolide, a gonadotropinreleasing hormone, also has been used for this indication. Hydroxyurea may be helpful in some patients. The use of antiandrogens is under investigation.6,27... 

Some clinicians transfuse patients to maintain an HbS level less than 30% to prevent recurrent priapism. Duration of such regimens should be limited to 6 to 12 months. 

Modalities to prevent priapism are limited and not well studied. Pseudoephedrine (30 or 60 mg/day given orally at bedtime) and leuprolide, a gonadotropin-releasing hormone, have been used to decrease the number of recurrent episodes of priapism. Hydroxyurea therapy may also be useful. Recently, low-doses of an antiandrogen, bicalutamide, have been used in two patients with SCD and one patient with spinal cord injury for treatment of recurrent and refractory priapism without major side effects. " " ... 

Fig. 13.3. Embolization of both internal pudendal arteries with coils in a patient with priapism and sickle cell disease. The aim of this treatment was to create permanent impotence and to prevent fibrosis...

The treatment of sickle cell priapism requires more disease-specific treatment, including oxygenation, hydration, alkalinization, exercise, analgesia and exchange transfusion. Anecdotal evidence supports the use of oral therapy with hydroxyurea and hydralazine (Al Jam a and Al Dabbous 1998). Etilefrine is an oral a-adrenoreceptor agonist that in the form of maintenance therapy may help prevent further attacks, with little effect on systemic blood pressure (Virag et al. 1996). Surgical spinal decompression has been recommended to alleviate priapism associated with lumbar spinal stenosis. 

Virag R, Bachir D, Lee K, Galacteros F (1996) Preventive treatment of priapism in sickle cell disease with oral and self-administered intracavernous injection of etilefrine. Urology 47 777-781 discussion 781... 

It is mandatory to exclude an arterial priapism by ultrasonography. If an arterial-lacunar fistula is demonstrated, the immediate treatment is conservative and consists of prolonged compression of the site of the fistula. Primary delayed treatment consists in percutaneous embolization of the fistula or microsurgical repair. Highly selective embolization of the cavernous artery seems to be the best option in order to prevent erectile dysfunction at long term (Savoca et al. 2004). 

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