title: Priapism of ambiguous classification in a sickle cell patient.
abstract: We report a case of recurrent priapism in a sickle cell patient who had undergone physiological transformation from a low-flow state to a mixed high-flow/low-flow picture. An oral alpha-adrenergic agonist/histamine-1 antagonist combination maintained a balance of potency without stutter in the latter state, whereas an oral alpha-adrenergic agonist in the early part of his course did not prevent priapic progression. Concomitant use of a non-steroidal anti-androgenic agent rendered him impotent despite good libido. Other etiologies should be considered in the setting of recurrent priapism and failed standard therapies; duplex ultrasound is useful in order to delineate the hemodynamics. This case supports contentions that priapism is a spectrum phenomenon, and raises questions regarding the mechanism by which alpha-adrenergic agents prevent priapic progression.
authors.affiliation: Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, New York 10467, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hoffman
authors.forename: A M
authors.initials: AM
authors.lastname: Kaynan
authors.forename: A
authors.initials: A
authors.lastname: Melman
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D000726:Androgen Antagonists / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications*; D000813:Anilides / Q000627:therapeutic use; D001783:Blood Flow Velocity; D002744:Chlorpheniramine / Q000627:therapeutic use; D004338:Drug Combinations; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009570:Nitriles; D010413:Penis / Q000098:blood supply; D010665:Phenylpropanolamine / Q000627:therapeutic use; D011317:Priapism / Q000209:etiology* / Q000503:physiopathology; D019233:Retreatment; D014105:Tosyl Compounds
chemical_list: D000316:Adrenergic alpha-Agonists; D000726:Androgen Antagonists; D000813:Anilides; D004338:Drug Combinations; D006634:Histamine H1 Antagonists; D009570:Nitriles; D014105:Tosyl Compounds; D010665:Phenylpropanolamine; D002744:Chlorpheniramine; C053541:bicalutamide