Researchers reported that patients with sickle cell disease (SCD) who present with acute ischemic priapism should be initially managed according to emergency urological protocol. The finding is published in The Journal of Urology. 

Priapism is colloquially known as an unwanted, prolonged erection. When a patient presents with priapism, physicians usually evaluate whether it is ischemic or nonischemic. Acute ischemic priapism requires early intervention. Patients with SCD are usually at a higher risk of experiencing ischemic priapism events and are advised to seek urological attention should they occur. 

It is important that the type of priapism be identified accurately prior to further intervention. The authors of the study wrote, “For the purposes of this guideline, recurrent ischemic priapism is narrowly defined as being a condition in which a patient experiences recurrent ischemic episodes with or without meeting the previously cited 4-hour criteria for acute ischemic priapism.” 

Read more about SCD etiology 

For the study, the Emergency Care Research Institute conducted a literature search of studies on acute ischemic priapism and nonischemic priapism. In addition, the Pacific Northwest Evidence-based Practice Center conducted a literature search on priapism following intracavernosal vasoactive medication and priapism in patients with SCD. A total of 203 unique articles were selected for review. 

From the data analyzed, a few pertinent recommendations were made. The researchers proposed that physicians should not delay the standard management of acute ischemic priapism in patients with SCD. In addition, clinicians should avoid using exchange transfusion as the primary treatment in patients with SCD who are diagnosed with acute ischemic priapism. 

The guidelines contained separate recommendations for nonischemic priapism, which is not an emergency condition. Physicians should offer patients an initial period of observation in such cases. The first-line therapy for nonischemic priapism is percutaneous fistula embolization. 

The researchers concluded that patients with SCD presenting with acute ischemic priapism should be offered urologic relief of the erection, concurrent with sickle cell assessment and interventions. 

Reference

Bivalacqua TJ, Allen BK, Brock G, et al. The diagnosis and management of recurrent ischemic priapism, priapism in sickle cell patients and non-ischemic priapism: an AUA/SMSNA guidelineJ Urol. 2022;101097JU0000000000002767. doi:10.1097/JU.0000000000002767