Prevalence of Priapism and Its Awareness amongst Male Homozygous Sickle Cell Patients in Lagos, Nigeria

Background. Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Impotence and infertility are major problems in male sickle cell disease patients, and priapism has been implicated as a cause of impotence and infertility. The aim of this study is to determine priapism prevalence and assess the knowledge of male homozygous male patients about it in Lagos, Nigeria. Methods. A cross-sectional study was conducted amongst male homozygous sickle cell disease patients of Lagos State University Teaching Hospital. Pretested questionnaires were distributed to determine the prevalence and assess their knowledge on priapism. Data were analyzed using SPSS version 16.0. Results. A total of 114 consenting subjects filled the questionnaires, 85 of 114 (74.6%) had not heard about priapism before this study. A total of 77 of 114 (67.5%) did not know that they are at risk of priapism. Whilst 84 of 114 (73.7%) were not aware that priapism is a complication of SCD. The majority, 94 of 114 (82.5%), were not aware that priapism could cause impotence. Conclusion. There is a need to create more awareness about this complication amongst sickle cell disease patients in order to stem the incidence of impotence and infertility amongst them. Background Sickle Cell Disease. Sickle cell disorder is a genetic abnormality involving haemoglobin and red cells. The glutamine on the 6th position of the chain is replaced with valine consequent on a single point mutation in which thymine replaces adenine on the deoxyribonucleic acid structure. Haemoglobin S resulting from the substitution causes polymerization of haemoglobin and red cell sickling on exposure to low-oxygen tension and unsickle on oxygenation. The sickled red cells obstruct blood vessels and impede free flow of blood of the affected vessel causing vascular congestion, oxygen deprivation, anaerobic glycolysis, lactic acidosis, and pain. This may be responsible for priapism, an acute complication of sickle cell disease. Priapism in Sickle Cell Disease. Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation Priapism is due to occlusion of the outflow vessels from the corpora cavernosa by sickled cells, consistent with significantly lower HbF levels in affected cases Priapism may be self limited, and of short duration usually lasting less than 3 hours. It may also be chronic and recurrent lasting more than 24 hours. Increased rate of impotence has been reported in sickle cell patients whose attacks lasted more than 24 hours Sexual intercourse has been implicated to precipitate attack amongst Jamaican. Others reported spontaneous attacks that wake the patient from sleep Many treatment modalities are available for priapism, these include the use of drugs, exchange blood transfusion and surgical intervention. Drugs like -adrenergic agonist which increase the contractile state of the trabecular/arterial meshwork and facilitate venous outflow from the corpora Adequate hydration and analgesia may dislodge the trapped sickled red cells, partial exchange blood transfusion to lower the HbS level to less than 30% has been tried Surgical interventions which is usually the last procedure for unresolved priapism involves aspiration and irrigation of the corpora cavernosa with saline Infertility is a major problem in male sickle cell disease patients reported by Abudu et al. in which they noted a lower testosterone levels in males compared with age-matched controls Methods This cross-sectional study to determine the prevalence and assess the knowledge of male sickle cell disease patients on Consenting participants were recruited consecutively into the study after obtaining the institution's ethics and research committee approval. Pretested questionnaires were distributed to them to determine the prevalence and assess their knowledge on priapism. The questionnaire was designed by the authors, adapted from previous related studies Statistical Assessment Data were analyzed using SPSS version 16.0 (Statistical Package for Social Sciences, Inc., Chicago, IL, USA). The descriptive data was given as mean ± standard deviation (SD). The Pearson chi-squared test was used to test for association between discrete variables. A value was considered to be statistically significant when <0.05. Result A total of 114 consenting subjects filled the questionnaires; the mean age was 21.97 ± 7.51, with a minimum of 14 years and maximum of 53 years. A total of 105 of 114 (92.1%) were single, while 9 of 114 (7.9%) were married. The majority, 65 of 114 (57%), had secondary education, 36 of 114 (31.6%) had tertiary education, 10 of 114 (8.8%) had primary education, while 3 of 114 (2.7%) had no education The A total of 23 of 45 (51.11%) did not get any treatment, 6 of 45 (13.33%) were admitted, and 8 of 45 (17.77%) were treated but not admitted. When asked about how many times they had episode of priapism, the majority, 11 of 45 (24.44%), had it twice followed by 9 of 45 (20%) once, 4 of 45 (8.8%) thrice, and 3 of 45 (6.66%) 5 times. When asked about precipitating factors, 17 of 45 (37.77%) had it after waking up from sleep followed by no known factors in 10 of 45 (22.22%), followed by 5 of 45 (11.11%) following bone pain crises, and 4 of 45 (8.88%) after sexual intercourse