Priapism in southwestern Nigeria.

OBJECTIVES To determine the aetiology, pattern of presentation, treatment regimen and outcome of management of priapism in our environment and to compare our findings with previous studies in this country and elsewhere. DESIGN A 10-year retrospective study from January 1991 to December 2000. SETTING Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. PATIENTS AND METHODS Hospital records of 16 patients managed for priapism over 10 years (January 1991 to December 2000) were analysed. Information extracted included the age, occupation, duration of symptoms, precipitating factors, past medical history, haemoglobin genotype, drug and social history, physical findings, treatment regimen, outcome of treatment, complications and duration of follow up. Eighteen patients were treated for priapism during the period but only sixteen case files available for analysis were reviewed in this study. RESULTS The mean age of the 16 patients under review was 20.4 years (range: 2.5-38 years). Thirteen patients (81%) were single and 10 (62.5%) were students. All the patients presented late with pain and woody hard penis with mean duration of eight days (range; 7 hrs-30 days). Eleven patients (68.7%) had previous episodes of priapism. Fourteen patients (87.5%) had sickle cell disease (SCD) and two (12.5%) were psychiatric patients on oral chlorpromazine. Associated medical conditions include urinary tract infection, malaria, acute urinary retention, bone pain crises and acute psychosis. All the patients received initial conservative management. Six patients had needle aspiration with irrigation plus injection of 2 ml of adrenaline solution (1 ml 1/1000 adrenaline in 200 ml saline) in both corpora cavernosa. One (16.7%) out of the six patients achieved full detumescence with normal erection. The remaining five patients later had cavernotomy with full detumescence and normal erection in three (60%) and weak erection in two (40%). Eight patients had Cavernosa-glandular shunt, full detumescence and normal erection was achieved in five patients (62.5%) while three (37.5%) became impotent. Two of the three patients with impotence presented with the longest duration of symptoms (14 and 30 days respectively), while the third patient reported earlier after five days, but he had suffered more than six (>6) previous attacks of priapism. Duration of hospital stay was 3-10 days and the average duration of follow up was 80.7 weeks. CONCLUSION Sickle cell disease account for 87.5% of priapism in our community. Late presentation and previous episodes of priapism, which are common features in most of these patients, are associated with poor prognosis with higher risk of impotence. Conservative management and aspiration with intracavernous adrenaline therapy appears ineffective in late case. However, good results obtained with surgery indicate that late presentation should not be a deterrent to surgical intervention. Surgeries in form of cavernotomy or cavernosa-glandular shunt, when carefully done, are effective and safe.