PRIAPISM IN SOUTHWESTERN NIGERIA

Abstract

ABSTRACT
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; 7hrs-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 2ml of adrenaline solution (1ml 1/1000 adrenaline in
200ml 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.