title: Priapism and sickle-cell anemia: diagnosis and nonsurgical therapy.
abstract: BACKGROUND
  Priapism describes a persistent erection lasting longer than 4 hours. Ischemic priapism and stuttering priapism are phenotypic manifestations of sickle-cell disease (SCD).
  
  
  OBJECTIVE
  To define the types of priapism associated with SCD, to address pathogenesis, and to recommend best practices.
  
  
  METHODS
  Literature review and published clinical guidelines.
  
  
  RESULTS
  Priapism is a full or partial erection that persists more than 4 hours. There are three kinds of priapism: ischemic priapism (veno-occlusive, low flow), stuttering priapism (recurrent ischemic priapism), and nonischemic priapism (arterial, high flow). Ischemic priapism is a pathologic phenotype of SCD. Ischemic priapism is a urologic emergency when untreated priapism results in corporal fibrosis and erectile dysfunction. The recommended treatment for ischemic priapism is decompression of the penis by needle aspiration and if needed, injection (or irrigation) with dilute sympathomimetic drugs. Stuttering priapism describes a pattern of recurring unwanted painful erections in men with SCD. Patients typically awaken with an erection that persists for several hours and becomes painful. The goals of managing stuttering ischemic priapism are: prevention of future episodes, preservation of erectile function, and balancing the risks vs. benefits of various treatment options. The current molecular hypothesis for stuttering priapism in SCD proposes that insufficient basal levels of phosphodiesterase type-5 are available in the corpora to degrade cyclic guanosine monophosphate (cGMP). Nocturnal erections result from normal neuronal production and surges of cGMP. In the context of SCD stuttering priapism, these nocturnal surges in cGMP go unchecked, resulting in stuttering priapism.
  
  
  CONCLUSIONS
  Considering the embarrassing nature of the problem and the dire consequences to erectile function, it is important to inform patients, parents, and providers about the relationship of SCD to prolonged painful erections. Prompt diagnosis and appropriate medical management of priapism are necessary to spare patients surgical interventions and preserve erectile function.
authors.affiliation: Department of Urology, Mayo Clinic, FL 32224, USA. broderick.gregory@mayo.edu
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Broderick
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications*; D002648:Child; D006801:Humans; D008297:Male; D010410:Penile Erection / Q000187:drug effects / Q000502:physiology; D010413:Penis / Q000000981:diagnostic imaging; D058986:Phosphodiesterase 5 Inhibitors / Q000009:adverse effects; D011317:Priapism / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D018615:Ultrasonography, Doppler, Color
chemical_list: D058986:Phosphodiesterase 5 Inhibitors