February 2000, Volume 12, Issue 1, Pages 59 - 63

Case Report

Priapism of ambiguous classification in a sickle cell patient S Hoffman, AM Kaynan & A Melman Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, New York, USA     Correspondence to: Dr A Melman, Department of Urology, Albert Einstein College of Medicine, Montefiore Medical Center, 3400 Bainbridge Ave 5th Floor, MAP Building, Bronx, NY 10467, USA.

Keywords

priapism;   sickle cell anemia;   alpha-adrenergic agonist;   histamine antagonist;   non-steroidal anti-androgen;   duplex ultrasound

Abstract

We report a case of recurrent priapism in a sickle cell patient who had undergone physiological transformation from a low-flow state to a mixed high-flow/low-flow picture. An oral alpha-adrenergic agonist/histamine-1 antagonist combination maintained a balance of potency without stutter in the latter state, whereas an oral alpha-adrenergic agonist in the early part of his course did not prevent priapic progression. Concomitant use of a non-steroidal anti-androgenic agent rendered him impotent despite good libido. Other etiologies should be considered in the setting of recurrent priapism and failed standard therapies; duplex ultrasound is useful in order to delineate the hemodynamics. This case supports contentions that priapism is a spectrum phenomenon, and raises questions regarding the mechanism by which alpha-adrenergic agents prevent priapic progression. International Journal of Impotence Research (2000) 12, 59-63.

Received 5 July 1999; Accepted 5 August 1999

^© Macmillan Publishers Ltd 2000