A wide variety of conditions have been associated with priapism. These may be classified as hematologic dyscrasias, erectogenic pharmacotherapy, nonerectogenic pharmacotherapy, neurological disorders, trauma, solid organ neoplasms, and idiopathic disorders.
Hematological Dyscrasias
Priapism is a major problem in patients with hemoglobinopathies. Homozygous sickle-cell disease (HbSS) has a strong association with priapism. This disease is quite common in persons of African or Mediterranean ethnicity.
Sickle-cell disease occurs in 1 in 150 live births in Jamaica, with the homozygous variant (HbSS) occurring in 1 in every 300 live births. Emond et al. noted a prevalence of priapism of 42% in Jamaican patients with sickle-cell disease, with a median age of onset of 21 years. The under-lying risk is thought to be due to abnormal sickle-shaped red blood cells obstructing venous drainage of the penis. These patients tend to have two patterns of presentation. They may present with major attacks, lasting as long as 24 h, or with brief, “stuttering” attacks which are usually nocturnal, multiple and last for <3 h. The latter usually did not result in erectile dysfunction. Emond reported a 25% rate of erectile dysfunction in patients who have had priapism. Though not commonly seen, priapism may also be seen in the sickle-cell trait (HbAS) or other combination genotypes, e.g. Hb Olmsted. Priapism may also be seen in thalassemia.
Thrombophilic states, as may be seen in patients with lupus, protein C deficiency, and polycythemia, have been associated with priapism. Priapism may be seen paradoxically in patients treated with the anticoagulants warfarin and heparin. High concentration fat emulsion (20%) in total parenteral nutrition may precipitate priapism. Canadian viagra online pharmacy The etiology in this case may be due to a hypercoaguable state with fat emboli or direct cellular effects by the fat contents. Priapism may be seen in patients on hemodialysis treated with heparin and may represent a rebound phenomenon. Fabry’s disease is a genetic disorder of glycosphingolipid metabolism, presenting with renal insufficiency and priapism. Other associated conditions include amyloidosis and glucose phosphate isomerase deficiency.
Priapism is also seen in hematological malignancies such as leukemias, lymphomas, and multiple myeloma. Asplenism and erythropoietin use has been associated with priapism. Priapism has also been associated with glucose-6-phosphate dehydrogenase deficiency.
Erectogenic Pharmacotherapy
With the introduction of intracavernosal treatment for erectile dysfunction in Canadian, the incidence of priapism has increased. Nieminen and Tammala reported that the etiology of priapism in 21% of patients in their series was due to intracavernosal therapy for erectile dysfunction. Intracavernosal papaverine, prostaglandin E1, and transurethral prostaglandin E1 have been associated with minor risks of priapism. Cialis in Canada Priapism resulting from the combination of alprostadil, papaverine, and phentolamine has been reported in 0.9% of users. Several case reports have been published on the association of priapism with sildenafil use. It is thought that younger patients with better baseline erectile function, patients with overt neurological disease, and patients without significant cardiovascular disease were more susceptible to priapism.
