There have been no deaths reported from priapism. However, deaths have been reported in patients who presented with priapism and other symptoms, but death has occurred because of other reason unrelated to priapism.
Can Priapism Cause Death?
There have been no deaths reported due to priapism. Priapism is caused by various disease such as sickle cell disease, leukemia, diabetes mellitus, renal failure, hemodialysis, neurological diseases, primary or secondary tumors and trauma. Most of these diseases are chronic and deadly diseases. Deaths are reported in patients who presented with priapism and other symptoms but these deaths are unrelated to priapism. This is clearly shown in the above discussions and case history.
Priapism is caused by many diseases like
- Haematological conditions-
- Sickle cell disease
- Multiple myeloma
- Primary or secondary tumors
- Neurological disorders – syphilis, spinal cord injury, rabies
Most of the diseases mentioned above are chronic and deadly diseases and death has occurred due to a reason of the disease unrelated to priapism.
The following discussions and case history will make you understand this well.
Sickle Cell Disease
Sickle cell disease (SCD) is one of the common causes of priapism. SCD causes prolong painful erections also known as low-flow or ischemic priapism and stuttering priapism which is a recurrent form of ischemic priapism. The lifetime prevalence of ischemic priapism in SCD range from 2-35%
SCD occurs due to S point mutation (HbS) in the β-globin chain of the hemoglobin molecule. Deoxygenation (hypoxia) results in aggregation of the HbS components and formation of needle-like hemoglobin chains which will change the shape of the red cell into a sickle shape. This is called sickling and it’s more common in highly vascular areas with low-flow states such as spleen, bone marrow, penis and any other inflamed tissue.
Sickling can cause occlusion of the vessel, depriving more oxygen and nutrient to the organ, ischemia of the organ and sudden death. This is called vaso-occlusive crisis and it’s predicated by hypoxia, infection, fever, anxiety, changes in the body temperature.
The common vaso-occlusive crisis affects the brain, lungs, spleen, bone marrow, kidney, and penis. The patients can die from pulmonary infarction, stroke or splenic infarction. Splenic infarction increase the susceptibility of bacterial infection from encapsulated organisms (Haemophilus influenza, Streptococcus pneumonia, and Neisseria meningitides) and death can occur from meningitis or septicemia.
Death in leukemia mainly occurs due to Systemic infection or lung infection (pneumonia). This is the most common cause responsible for death in leukemia.
Hemorrhage due to reduced platelets levels and disseminated intravascular coagulation (blood clots forming in blood vessels).
A 6-year-old boy presented with a painful erection of the penis of 12 hour duration. This started spontaneously and had been preceded by a one day history of fever which was ongoing. He was able to urinate but with difficulty. There was no previous history of priapism, no episodes of limb or joint pain. He was not taking any medications and his immunizations were up-to-date.
On examination he appeared in severe pain, he had a fever of 38.5°C and heart rate of 130 bpm. He had an erect swollen penis which was painful to examine. The rest of the examination was unremarkable.
His investigations were normal, he was started on intravenous fluid, morphine and antibiotics. His condition improved and priapism started to resolve therefore, surgery was not done. However on the second day the mother noted his behavioral changes, he would get agitated and choke when he was made to drink fluids. His condition worsened, he was very aggressive, confused and did not recognized his parents. He was also noted to have excessive salivation. His condition deteriorated in few hours and shortly after this he died.
The diagnosis was rabies encephalopathy. The mother remembered that the boy was bitten by a dog one month back. As you see the priapism was due to a neurological cause. The death was not related to priapism at all.
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