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Published in: Journal of Medical Case Reports 1/2020

Open Access 01-12-2020 | Priapism | Case report

Using cyproterone acetate to treat recurrent ischemic priapism in a patient with sickle cell anemia as a comorbidity: a case report

Author: Ali Alshahrani

Published in: Journal of Medical Case Reports | Issue 1/2020

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Abstract

Introduction

The management of recurrent ischemic priapism is unclear in contemporary practice. Yet, if left untreated, the condition may evolve into an acute ischemic priapism and in some cases result in erectile dysfunction. This report documents the results of successful management of recurrent ischemic priapism using cyproterone acetate in a 30-year-old Saudi man with sickle cell anemia as a comorbidity.

Case presentation

A 30-year-old Saudi man denoted visited the emergency room with a painful erection which had lasted for more than four hours. The patient has sickle cell anemia and a family history of sickle cell disease. He is married and has two children. His first priapism case occurred when he was 7 years old. At the age of 15, the condition recurred, and the patient’s doctor prescribed cyproterone acetate 50 mg twice daily for 5 days. The doctor had told him that whenever he was experiencing priapism, he should adhere to this regimen for 5 days. The doctor could not find any guidelines for the prescription of cyproterone acetate.

Conclusion

Priapism cases represent a significant challenge in therapeutic management because of the elevated risk of structural damage to the penis. The fact that there lacks a clinically approved standard approach to managing the condition make it difficult for physicians to effectively manage the condition. Management of the condition is further complicated by existence of comorbidities such as sickle cell anemia. This patient’s case demonstrates that cyproterone acetate prescription is a great preventative strategy that limits priapism recurrences.
Literature
1.
go back to reference Ferré A, Vila J, Jurado MJ, et al. Sleep-related painful erections associated with obstructive sleep apnea syndrome. Arch Sex Behav. 2012;41:1059–63..CrossRef Ferré A, Vila J, Jurado MJ, et al. Sleep-related painful erections associated with obstructive sleep apnea syndrome. Arch Sex Behav. 2012;41:1059–63..CrossRef
2.
go back to reference Chiner E, Sancho-Chust JN, Llombart M, et al. Sleep-related painful erection in a 50-year-old man successfully treated with cinitapride. J Sex Med. 2010;7:3789–92.CrossRef Chiner E, Sancho-Chust JN, Llombart M, et al. Sleep-related painful erection in a 50-year-old man successfully treated with cinitapride. J Sex Med. 2010;7:3789–92.CrossRef
3.
go back to reference Kuhadiya ND, Desai A, Reisner M. Sleep-related painful erections in an elderly man successfully treated using clonazepam. J Am Geriatr Soc. 2014;62:407–8.CrossRef Kuhadiya ND, Desai A, Reisner M. Sleep-related painful erections in an elderly man successfully treated using clonazepam. J Am Geriatr Soc. 2014;62:407–8.CrossRef
4.
go back to reference De Freitas G, Soares D, Rhoden EL. A 35-year old man presenting sleep-related painful erections (Erpes): a case report and review of a literature. Adv Sex Med. 2014;4:6–10.CrossRef De Freitas G, Soares D, Rhoden EL. A 35-year old man presenting sleep-related painful erections (Erpes): a case report and review of a literature. Adv Sex Med. 2014;4:6–10.CrossRef
5.
go back to reference Abouda M, Jomni T, Yangui F, et al. Sleep-related painful erections in a patient with obstructive sleep apnea syndrome. Arch Sex Behav. 2016;45:241–5.CrossRef Abouda M, Jomni T, Yangui F, et al. Sleep-related painful erections in a patient with obstructive sleep apnea syndrome. Arch Sex Behav. 2016;45:241–5.CrossRef
6.
go back to reference Rourke KF, Fischler AH, Jordan GH. Treatment of recurrent idiopathic priapism with oral baclofen. J Urol. 2002;168:2552–3.CrossRef Rourke KF, Fischler AH, Jordan GH. Treatment of recurrent idiopathic priapism with oral baclofen. J Urol. 2002;168:2552–3.CrossRef
7.
go back to reference van Driel MF, Beck JJ, Elzevier HW, et al. The treatment of sleep-related painful erections. J Sex Med. 2008;5:909–18.CrossRef van Driel MF, Beck JJ, Elzevier HW, et al. The treatment of sleep-related painful erections. J Sex Med. 2008;5:909–18.CrossRef
8.
go back to reference Traish A, Kim N. The physiological role of androgens in penile erection: regulation of corpus cavernosum structure and function. J Sex Med. 2005;2:759–70.CrossRef Traish A, Kim N. The physiological role of androgens in penile erection: regulation of corpus cavernosum structure and function. J Sex Med. 2005;2:759–70.CrossRef
9.
go back to reference Burnett AL, Bivalacqua TJ, Champion HC, et al. Feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent priapism. J Sex Med. 2006;3:1077–84.CrossRef Burnett AL, Bivalacqua TJ, Champion HC, et al. Feasibility of the use of phosphodiesterase type 5 inhibitors in a pharmacologic prevention program for recurrent priapism. J Sex Med. 2006;3:1077–84.CrossRef
10.
go back to reference Yamashita N, Hisasue S, Kato R, et al. Idiopathic stuttering priapism: recovery of detumescence mechanism with temporal use of antiandrogen. Urology. 2004;63:1182–4.CrossRef Yamashita N, Hisasue S, Kato R, et al. Idiopathic stuttering priapism: recovery of detumescence mechanism with temporal use of antiandrogen. Urology. 2004;63:1182–4.CrossRef
11.
go back to reference Cordero A, Bertomeu-Martinez V, Mazon P, et al. Erectile dysfunction in high-risk hypertensive patients treated with beta-blockade agents. Cardiovasc Ther. 2010;28:15–22.CrossRef Cordero A, Bertomeu-Martinez V, Mazon P, et al. Erectile dysfunction in high-risk hypertensive patients treated with beta-blockade agents. Cardiovasc Ther. 2010;28:15–22.CrossRef
12.
go back to reference Lagoda G, Sezen SF, Hurt KJ, et al. Sustained nitric oxide (NO)-releasing compound reverses dysregulated NO signal transduction in priapism. FASEB J. 2014;28:76–84.CrossRef Lagoda G, Sezen SF, Hurt KJ, et al. Sustained nitric oxide (NO)-releasing compound reverses dysregulated NO signal transduction in priapism. FASEB J. 2014;28:76–84.CrossRef
13.
go back to reference Burnett AL, Anele UA, Trueheart IN, et al. Randomized controlled trial of sildenafil for preventing recurrent ischemic priapism in sickle cell disease. Am J Med. 2014;127:664–8.CrossRef Burnett AL, Anele UA, Trueheart IN, et al. Randomized controlled trial of sildenafil for preventing recurrent ischemic priapism in sickle cell disease. Am J Med. 2014;127:664–8.CrossRef
14.
go back to reference Tzortzis V, Mitrakas L, Gravas S, et al. Oral phosphodiesterase type 5 inhibitors alleviate recurrent priapism complicating thalassemia intermedia: a case report. J Sex Med. 2009;6:2068–71.CrossRef Tzortzis V, Mitrakas L, Gravas S, et al. Oral phosphodiesterase type 5 inhibitors alleviate recurrent priapism complicating thalassemia intermedia: a case report. J Sex Med. 2009;6:2068–71.CrossRef
15.
go back to reference Bivalacqua TJ, Musicki B, Hsu LL, et al. Sildenafil citrate-restored eNOS and PDE5 regulation in sickle cell mouse penis prevents priapism via control of oxidative/nitrosative stress. PLoS One. 2013;8:e68028.CrossRef Bivalacqua TJ, Musicki B, Hsu LL, et al. Sildenafil citrate-restored eNOS and PDE5 regulation in sickle cell mouse penis prevents priapism via control of oxidative/nitrosative stress. PLoS One. 2013;8:e68028.CrossRef
16.
go back to reference Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, et al. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010;7:476–500.CrossRef Broderick GA, Kadioglu A, Bivalacqua TJ, Ghanem H, Nehra A, et al. Priapism: pathogenesis, epidemiology, and management. J Sex Med. 2010;7:476–500.CrossRef
17.
go back to reference Aliyu ZY, Kato GJ, Taylor J, Babadoko A, Mamman AI, et al. Sickle cell disease and pulmonary hypertension in Africa: a global perspective and review of epidemiology, pathophysiology, and management. Am J Hematol. 2008;83:63–70.CrossRef Aliyu ZY, Kato GJ, Taylor J, Babadoko A, Mamman AI, et al. Sickle cell disease and pulmonary hypertension in Africa: a global perspective and review of epidemiology, pathophysiology, and management. Am J Hematol. 2008;83:63–70.CrossRef
18.
go back to reference Pierorazio PM, Bivalacqua TJ, Burnett A. Daily phosphodiesterase type-5 inhibitor therapy as rescue for recurrent ischemic priapism after failed androgen ablation: a case report. J Androl. 2011;32:371–4.CrossRef Pierorazio PM, Bivalacqua TJ, Burnett A. Daily phosphodiesterase type-5 inhibitor therapy as rescue for recurrent ischemic priapism after failed androgen ablation: a case report. J Androl. 2011;32:371–4.CrossRef
19.
go back to reference Dahm P, Rao DS, Donatucci CF. Antiandrogens in the treatment of priapism. Urology. 2002;59:138.CrossRef Dahm P, Rao DS, Donatucci CF. Antiandrogens in the treatment of priapism. Urology. 2002;59:138.CrossRef
20.
go back to reference Shamloul R, el Nashaar A. Idiopathic stuttering priapism treated successfully with low-dose ethinyl estradiol: a single case report. J Sex Med. 2005;2:732–4.CrossRef Shamloul R, el Nashaar A. Idiopathic stuttering priapism treated successfully with low-dose ethinyl estradiol: a single case report. J Sex Med. 2005;2:732–4.CrossRef
21.
go back to reference Levine LA, Estrada CR, Latchamsetty KC. Idiopathic ischemic priapism. preventing recurrence. Contemp Urol. 2004;16:25–34. Levine LA, Estrada CR, Latchamsetty KC. Idiopathic ischemic priapism. preventing recurrence. Contemp Urol. 2004;16:25–34.
22.
go back to reference Rachid-Filho D, Cavalcanti AG, Favorito LA, Costa WS, Sampaio FJ. Treatment of recurrent priapism in sickle cell anemia with finasteride: a new approach. Urology. 2009;74:1054–7.CrossRef Rachid-Filho D, Cavalcanti AG, Favorito LA, Costa WS, Sampaio FJ. Treatment of recurrent priapism in sickle cell anemia with finasteride: a new approach. Urology. 2009;74:1054–7.CrossRef
23.
go back to reference Wen J, Jiang X, Dai Y, Zhang Y, Tang Y, et al. Increased adenosine contributes to penile fibrosis, a dangerous feature of priapism, via A2B adenosine receptor signaling. FASEB J. 2010;24:740–9.CrossRef Wen J, Jiang X, Dai Y, Zhang Y, Tang Y, et al. Increased adenosine contributes to penile fibrosis, a dangerous feature of priapism, via A2B adenosine receptor signaling. FASEB J. 2010;24:740–9.CrossRef
24.
go back to reference DeCastro BJ, Costabile RA, McMann LP, Peterson AC. Oral ketoconazole for prevention of postoperative penile erection: a placebo controlled, randomized, double-blind trial. J Urol. 2008;179:1930–2.CrossRef DeCastro BJ, Costabile RA, McMann LP, Peterson AC. Oral ketoconazole for prevention of postoperative penile erection: a placebo controlled, randomized, double-blind trial. J Urol. 2008;179:1930–2.CrossRef
25.
go back to reference Muneer A, Minhas S, Arya M, Ralph DJ. Stuttering priapism—a review of the therapeutic options. Int J Clin Pract. 2008;62:621265.CrossRef Muneer A, Minhas S, Arya M, Ralph DJ. Stuttering priapism—a review of the therapeutic options. Int J Clin Pract. 2008;62:621265.CrossRef
26.
go back to reference Kanika ND, Tar M, Tong Y, Kuppam DS, Melman A, et al. The mechanism of opiorphin-induced experimental priapism in rats involves activation of the polyamine synthetic pathway. Am J Physiol Cell Physiol. 2009;297:916–27.CrossRef Kanika ND, Tar M, Tong Y, Kuppam DS, Melman A, et al. The mechanism of opiorphin-induced experimental priapism in rats involves activation of the polyamine synthetic pathway. Am J Physiol Cell Physiol. 2009;297:916–27.CrossRef
27.
go back to reference Dai Y, Zhang Y, Phatarpekar P, Mi T, Zhang H, et al. Adenosine signaling, priapism and novel therapies. J Sex Med. 2009;6(3):292–301.CrossRef Dai Y, Zhang Y, Phatarpekar P, Mi T, Zhang H, et al. Adenosine signaling, priapism and novel therapies. J Sex Med. 2009;6(3):292–301.CrossRef
28.
go back to reference Ahmed AA, Marki A, Gaspar R, Vasas A, Mudawi MM, et al. β2-adrenergic activity of 6-methoxykaempferol-3-O-glucoside on rat uterus: in vitro and in silico studies. Eur J Pharmacol. 2011;667:348–54.CrossRef Ahmed AA, Marki A, Gaspar R, Vasas A, Mudawi MM, et al. β2-adrenergic activity of 6-methoxykaempferol-3-O-glucoside on rat uterus: in vitro and in silico studies. Eur J Pharmacol. 2011;667:348–54.CrossRef
29.
go back to reference Muneer A, Ralph D. Guideline of guidelines: priapism. BJU Int. 2017;119:204–8.CrossRef Muneer A, Ralph D. Guideline of guidelines: priapism. BJU Int. 2017;119:204–8.CrossRef
30.
go back to reference Salonia Y, Eardley I, Giuliano F, et al. European Association of Urology guidelines on priapism. Eur Urol. 2014;65:480–9.CrossRef Salonia Y, Eardley I, Giuliano F, et al. European Association of Urology guidelines on priapism. Eur Urol. 2014;65:480–9.CrossRef
Metadata
Title
Using cyproterone acetate to treat recurrent ischemic priapism in a patient with sickle cell anemia as a comorbidity: a case report
Author
Ali Alshahrani
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Journal of Medical Case Reports / Issue 1/2020
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/s13256-020-02527-1

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