Efficacy of intracavernous etilefrin injections in curative treatment of priapism in sickle-cell patients

OBJECTIVE: To date, the treatment of priapism in sickle-cell patients has r elied an measures aimed at lowering blood viscosity and acidosis and reduci ng the level of circulating hemoglobin S (hyperhydration, alkalinization, o r exsanguinotransfusion...) Surgical cavernous-venous shunt may be proposed if conservative treatment fails. We examined the efficacy of intracavernou s etilefrin injections. PATIENTS AND METHODS: From January 1996 through October 1997 (20 months) we performed 35 consecutive intracavernous injections of an alphastimulant, e tilefrin in 7 sickle-cell patients (6 SS, 1 AS) who had experienced one or several episodes of low-flow priapism lasting 2 to 28 hours. RESULTS: Involution of the tumefaction was rapidly achieved in all cases. T olerance was satisfactory, although some post-injection undesirable effects were reported by certain patients: moderate transient pain (2-5 min) in th e retrosternal area, or intense pain in the penis (more intense than the pr iapism) which lasted 10 to 30 minutes. This work confirmed the earlier repo rted efficacy of intracavernous injections of etilefrin and suggests that t he autonomous nervous system plays an important role in the genesis of this condition in sickle-c:ell patients. Patients should be informed about the observed undesirable effects which have not been reported previously in the literature. CONCLUSION: Etilefrin can be proposed as first line treatment for priapism in sickle-cell patients (at least in cases lasting less than 24 h). The pat hogenic mechanism could involve neuromuscular dysfunction.