Priapism is a rare condition with an overall incidence of 1.5 cases per 100,000 person-years. In men older than 40 years, the incidence increases to 2.9 cases per 100,000 person-years.
Priapism has been described in adults the main cause is the usage of erectile dysfunction drugs and other drugs, but in some populations like African, American-African people the main cause is sickle cell disease. In pediatric population the main cause is sickle cell disease.
What Is The Prognosis For Priapism?
Prognosis of priapism depends on several factors and the following prognosis factors and figures have been reported from clinical research studies.
Duration of Symptoms
The prognosis is very good if the patient present with symptoms within 4-6 hours. Most of these patients remained potent.
When treatment was initiated within 24 hours of symptoms, 92% of patients remained potent.
Prognosis tends to get worst when the patient presents late.
One study showed only 22% of males were potent with a priapism attack that lasted more than 7 days.
Underlying Pathology
The prognosis of ischemic priapism mainly depends on the time taken to restore normal blood flow to the penis.
Prognosis of non-ischemic priapism is usually good because the blood supply is not compromised, only deranged. Usually non-ischemic priapism does not cause erectile dysfunction.
Intractable, therapy-resistant, acute ischemic priapism or episodes lasting more than 48-72 hours usually result in complete erectile dysfunction with possible major penile deformity.
Early Interventions
Early interventions done for priapism will preserve the normal erectile function of the penis; however, clinical trials have not been done on identifying whether the type of treatment (conservative/medical and surgical interventions) makes a significant difference in the prognosis. From the studies done both conservative/medical and surgical managements are proven to be beneficial and early interventions have given a good prognosis.
Previous Priapism Episodes
Those who had previous priapism were noticed to have a higher incidence of complications (60%) compared to 40% in those who were presenting for the first time.
Previous Stuttering Episodes
In one study 78.9% of patients had stuttering priapism and these patients developed more complications even more than patients who had previous priapism. This might have been because these patients with stuttering priapism must have neglected the symptoms whereas when the patient had a previous major priapism episode they tend to seek medical advice earlier with the second episode.
Presence of Sickle Cell Disease
Sickle cell disease is identified as one of the main causes for priapism in some populations like African, American-African. It’s also the main cause of priapism in children. The rate of priapism in adults with sickle cell disease is as high as 89%. The rate of priapism among children with SCD is about 27%. Presence of sickle cell disease increased the risk of getting stuttering priapism as well.
Infections
If an infection develop after an attack priapism the prognosis can get worst. The source of the infection can be from the trauma that caused non-ischemic priapism or during the surgical procedure the infection might have spread.
Summary
Priapism is a rare condition with an overall incidence of 1.5 cases per 100,000 person-years. In men older than 40 years, the incidence increases to 2.9 cases per 100,000 person-years. The prognosis of priapism depends on duration of symptoms, underlying pathology, early interventions, previous priapism episodes, previous stuttering episodes, presence of sickle cell disease and the presence of infections in the penis.
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