PRIAPISM IN SOUTHWESTERN NIGERIA

ABSTRACTObjectives: To determine the aetiology, pattern of presentation, treatment regimen andoutcome of management of priapism in our environment and to compare our findingswith 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 10years (January 1991 to December 2000) were analysed. Information extracted includedthe 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 weretreated for priapism during the period but only sixteen case files available for analysiswere reviewed in this study.Results: The mean age of the 16 patients under review was 20.4 years (range: 2.5-38years). Thirteen patients (81%) were single and 10 (62.5%) were students. All thepatients presented late with pain and woody hard penis with mean duration of eightdays (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 psychiatricpatients on oral chlorpromazine. Associated medical conditions include urinary tractinfection, malaria, acute urinary retention, bone pain crises and acute psychosis. Allthe patients received initial conservative management. Six patients had needle aspirationwith irrigation plus injection of 2ml of adrenaline solution (1ml 1/1000 adrenaline in200ml saline) in both corpora cavernosa. One (16.7%) out of the six patients achievedfull detumescence with normal erection. The remaining five patients later had cavernotomywith full detumescence and normal erection in three (60%)and weak erection in two(40%). Eight patients had Cavernosa-glandular shunt, full detumescence and normalerection 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 ofsymptoms (14 and 30 days respectively), while the third patient reported earlier afterfive days, but he had suffered more than six (>6) previous attacks of priapism. Durationof 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. Latepresentation and previous episodes of priapism, which are common features in mostof these patients, are associated with poor prognosis with higher risk of impotence.Conservative management and aspiration with intracavernous adrenaline therapyappears ineffective in late case. However, good results obtained with surgery indicatethat late presentation should not be a deterrent to surgical intervention. Surgeries inform of cavernotomy or cavernosa-glandular shunt, when carefully done, are effectiveand safe