Clinical Characteristics And Outcome Of Management Of Priapism At The Lagos State University Teaching Hospital

摘要

IntroductionPriapism though an infrequent condition, can be associated with the significant morbidity of erectile dysfunction. While it is an idiopathic occurrence in the majority of cases involving Caucasians, there have only few reviews in our environment with conflicting reports on its aetiology. We therefore aim to review our experience.Materials and MethodWe reviewed the records of all patients presenting to our hospital with priapism over a 5 year period from January 2006.ResultsThe record of 46 (82.1%) out of 56 patients who presented with priapism over the period were available for review. The mean age was 25.4 years and mean duration of symptom was 74.4hours. All the patients had ishaemic type of Priapism. The most common aetiological factor was haemoglobinopathy in 29 (63%) patients while the use of aphrodisiac occurred in 4 (8.7%) patients. There was no identified aetiology (idiopathic) in 10 (21.7%) patients.Three patients (6.5%) had spontaneous resolution. Thirty-six patients (78.3%) were treated with corporal aspiration only, out of which 14 patients (38.9%) needed a repeat aspiration for resolution to occur. Seven patients (15.2%) underwent surgical shunting procedures. The mean duration of hospital stay was 5.8 days. Only 34 patients were available for a follow up review a month after discharge. The identified complications in these patients were erectile dysfunction in 10 (29.4%) and wound sepsis in 5 (14.7% ). There was a statistically significant correlation between late presentation and development of complication following treatment (p=0.036) ConclusionHaemoglobinopathy is the most common aetiological factor for priapism amongst patients presenting to our institution. Use of aphrodisiacs is an uncommon cause. Late presentation still remains a problem amongst patients with priapism in our environment and it is a predictor of complications following treatment. We found corporal aspiration to be an effective treatment. Introduction Priapism is persistent penile erection in the absence of sexual stimulation. One of the earliest description of priapism in medical literature was by Trippe in 1845 (1) though early descriptions were also mentioned in pharaonic papyri (2). The two types of priapism described are low flow (or ischaemic) type and the high flow (or non-ischaemic) type. The ischaemic type of priapism is the commoner of the two types. Pathophysiologically, priapism occurs due to an abnormal distension of the corporal carvenosa with blood which is deoxygenated in the ischaemic type of priapism and oxygenated in the non-ischaemic type. The distension of the corpora carvernosa with deoxygenated blood leads to hypoxic injury to the carvenosal tissue hence patients with ischaemic priapism tend to experience a lot of pain with the persistent penile erection. This is unlike patients with the non-ischaemic priapism who still have adequate oxygenation of their carvenosal tissue and thus have a painless persistent penile erection. Most cases of the non-ischaemic priapism follow some form of genitourinary trauma or the other. Most cases of the Ischaemic priapism are thought to be idiopathic amongst Caucasians. Other aetiological factors previously implicated for ischaemic priapism include haemoglobinopathy, pelvic tumours, pelvic infections, trauma and use of medications.There are a few reports about priapism in our environment reporting different aetiological factors. One of such report by Aghaji et al in 2000 (3) cited the use of aphrodisiacs as the most common cause of priapism in adult Nigerians whereas another report three years later by Badmus et al found Haemoglobinopathy ( HbSS ) to be the most common aetiological factor in priapism in southwestern Nigeria (4). There has also been little mention of the duration of symptom before presentation in our environment. Moreso, the pattern of the aetiology of priapism has been known to change with time (5). There is therefore the need to study the current pattern o