Priapism at any encounter is a medical emergency that if we do not take action early, impotence becomes an inevitable misfortune.
Amongst the common acute complications of sickle cell disease is priapism, and knowing what this means and how to manage it, is paramount whether you are a health centre II or referral hospital.
Priapism is defined as a sustained, unwanted painful erection, lasting four or more hours. When there are multiple episodes of unwanted priapism that are self-limiting and last less than 4 hours, we term it stuttering priapism.
Priapism affects up to 35% of boys and men, and it is usually of the low flow ischemic type, often presenting with pain and a soft glans.
If you attempt to aspirate blood from the corpora cavernosa, it is usually dark, has a low pH, pO2 and glucose concentration.
When you diagnose priapism early, you will initiate conservative medical management promptly. Detumescence will remit. It isn’t only required but also limits the need for invasive interventions.
We can write this statement a thousand times. “Delayed diagnosis of priapism and therapy can result in impotence.
Let’s look at the recommendations that govern its management.
Ø For an episode of priapism lasting 4 hours or longer, initiate interventions to include
– Vigorous oral or intravenous hydration and oral or intravenous analgesia.
– Consultation with a urologist who can perform further evaluation and intervention for symptoms that do not remit with initial conservative medical management.
Ø Do not use transfusion therapy for immediate treatment of priapism associated with SCD.
Ø Consult with a haematologist for possible preoperative transfusion if surgical intervention is required.
It is crucial to acknowledge the scarcity of specialists in remote settings, but this does not stop you from correct management if a referral isn’t feasible.
Many senior doctors are reachable by a mere phone call: help becomes within reach. Please do not play the hero on someone’s reproductive organ.
It is vital to acknowledge the panel of experts on evidence-based management of sickle cell disease who designed these recommendations.
Don’t forget to share. Spread awareness.