Treatments for long-lasting and painful erection of the penis in boys and men with sickle cell disease

Priapism (the prolonged painful erection of the penis) is common in males with sickle cell disease (SCD). The length of time priapism lasts differs for different types and so does the medical treatment for it. Self-management approaches may be helpful. We looked for randomised controlled trials of different treatments to find the best option. We found one study set in Jamaica in 1985 with 11 people. In the study, stilboestrol was compared to placebo. The study only reports one of the outcomes from the review, how often stuttering priapism occurs. There is no difference between treatment groups for this outcome. Due to lack of evidence, we are not able to conclude the best treatment of priapism in SCD. Alpha agonists have become the treatment of choice for acute fulminant priapism and to prevent stuttering priapism. However, this is not supported by a randomised controlled trial. More research is needed. One trial is under way in the UK at this moment in time.

Authors' conclusions: 

There is a lack of evidence for the benefits or risks of the different treatments for both stuttering and fulminant priapism in sickle cell disease. This systematic review has clearly identified the need for well-designed, adequately-powered, multicentre randomised controlled trials assessing the effectiveness of specific interventions for priapism in sickle cell disease.

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Background: 

Sickle cell disease comprises a group of genetic haemoglobin disorders. The predominant symptom associated with sickle cell disease is pain resulting from the occlusion of small blood vessels by abnormally 'sickle-shaped' red blood cells. There are other complications, including chronic organ damage and prolonged painful erection of the penis, known as priapism. Severity of sickle cell disease is variable, and treatment is usually symptomatic. Priapism affects up to half of all men with sickle cell disease, however there is no consistency in treatment. We therefore need to know the best way of treating this complication in order to offer an effective interventional approach to all affected individuals.

Objectives: 

To assess the benefits and risks of different treatments for stuttering (repeated short episodes) and fulminant (lasting for six hours or more) priapism in sickle cell disease.

Search strategy: 

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also searched the internet for further references.

Date of the most recent search of the Group's Trials Register: 22 July 2010.

Selection criteria: 

All randomised or quasi-randomised controlled trials comparing non-surgical or surgical treatment with placebo or no treatment, or with another intervention for stuttering or fulminant priapism.

Data collection and analysis: 

The authors independently extracted data and assessed study quality.

Main results: 

Only one study of 11 participants was identified and met the criteria for inclusion in this review. This study compared stilboestrol to placebo. The only outcome specified in this review, which was assessed in the study, was reduction in frequency of stuttering priapism and there was no difference between the groups, risk ratio 0.18 (95% confidence interval 0.01 to 2.54).

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