II. Epidemiology
-
Incidence of Priapism in Sickle Cell Anemia
- Occurs in 35 to 45% of male SCA patients (up to 89% of patients by age 20 years old)
III. Pathophysiology
- Sickled RBCs sludge in the corpora cavernosa veins
- Results in low-flow ischemic Priapism
IV. Management
- Duration: <2 hours
- Duration: 2-4 hours
- First
- Intracavernosal Epinephrine (1:1,000,000 dilution) or Phenylephrine injection
- Other measures
- Nifedipine 10 mg (in repeated doses)
- First
- Duration >4 hours
- Administer above measures if not already attempted
- Exchange transfusion
- No longer routinely recommended (but may consult hematology)
- Do not delay other specific Priapism management
- Risk of CVA symptoms
- Epidural Anesthesia
- Urology Consultation indications
- Discharge criteria
- Priapism resolves and no recurrence during observation in ED
V. Prevention
-
Nitroglycerin Patch (0.2 - 0.4 mg/hour)
- Applied at bedtime may prevent nighttime attacks
VI. Course
- Often resolves spontaneously and may occur frequently
- However, persistent Priapism >2 hours should be aggressively managed to prevent complications
VII. Complications
- Repeated Priapism results
- Cellular damage and fibrosis
- Thickening and gross enlargement of the penis
- Penis may remain semi-erect
-
Impotence
- Penile Implants may be required
VIII. References
- Dwyer, Kleinmann, Goswami and Lopez (2025) Crit Dec Emerg Med 39(1): 26-35
- Glassberg and Weingart in Majoewsky (2012) EM: Rap 12(9): 4
- Yawn (2015) Am Fam Physician 92(12): 1069-76 [PubMed]
