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What is the effectiveness of surgical and non-surgical therapies in the treatment of ischemic priapism in patients with sickle cell disease? A systematic review by the EAU Sexual and Reproductive Health Guidelines Panel

International Journal of Impotence Research volume 36, pages 20–35 (2024)Cite this article

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Abstract

Sickle cell disease (SCD) is an inherited hemoglobin disorder characterized by the occlusion of small blood vessels by sickle-shaped red blood cells. SCD is associated with a number of complications, including ischemic priapism. While SCD accounts for at least one-third of all priapism cases, no definitive treatment strategy has been established to specifically treat patients with SC priapism. The aim of this systematic review was to assess the efficacy and safety of contemporary treatment modalities for acute and stuttering ischemic priapism associated with SCD. The primary outcome measures were defined as resolution of acute priapism (detumescence) and complete response of stuttering priapism, while the primary harm outcome was as sexual dysfunction. The protocol for the review has been registered (PROSPERO Nr: CRD42020182001), and a systematic search of Medline, Embase, and Cochrane controlled trials databases was performed. Three trials with 41 observational studies met the criteria for inclusion in this review. None of the trials assessed detumescence, as a primary outcome. All of the trials reported a complete response of stuttering priapism; however, the certainty of the evidence was low. It is clear that assessing the effectiveness of specific interventions for priapism in SCD, well-designed, adequately-powered, multicenter trials are strongly required.

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Fig. 1: Risk of Bias Summary and Graph of Included RCTs.
Fig. 2: Risk of Bias Graph and Summary of Observational Studies.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the participants for their cooperation.

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Author notes

  1. These authors contributed equally: Minhas S, Salonia A.

Authors and Affiliations

  1. Department of Urology, Selcuk University School of Medicine, Urology, Konya, Turkey

    M. Gül & Murat Gül

  2. Urological Research Institute, IRCCS Ospedale San Raffaele, Experimental Oncology/Unit of Urology, Milan, Italy

    B. Luca & Luca Boeri

  3. University of Aberdeen, Academic Urology Unit, Aberdeen, UK

    K. Dimitropoulos, M. I. Omar & Konstantinous Dimitropoulos

  4. ASST-Sette Laghi, Circolo & Fondazione Macchi Hospital, University of Insurbria, Varese, Italy

    P. Capogrosso & Paolo Capogrosso

  5. University of Leuven, Laboratory for Experimental Urology, Leuven, Belgium

    U. Milenkovic & Uros Milenkovic

  6. Careggi Hospital, University of Florence, Urology, Florence, Italy

    A. Cocci & Andrea Cocci

  7. Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Urology, Newcastle, UK

    R. Veeratterapillay

  8. Julius-Maximilians-University of Würzburg, Urology and Pediatric Urology, Würzburg, Germany

    G. Hatzichristodoulou

  9. Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Andrology Centre, Manchester, UK

    V. Modgil

  10. Vittorio Emanuele II, University of Catania, Urology, Catania, Italy

    G. I. Russo & Giorgio Ivan Russo

  11. Charing Cross Hospital, Imperial College Healthcare NHS Trust, Urology, London, UK

    T. Tharakan & Tharu Tharakan

  12. Taksim Education and Research Hospital, Department of Urology, Istanbul, Turkey

    A. Kalkanli & Arif Kalkanli

  13. University of Foggia, Department of Urology, Foggia, Italy

    C. Bettocchi

  14. Lusófona University of Humanities and Technologies, School of Psychology and Life Sciences, Lisbon, Portugal

    J. Carvalho & J. P. Pereira de Carvalho

  15. Azienda Usl Bologna Maggiore-Bellaria Hospital, Endocrinology Unit, Bologna, Italy

    G. Corona & Giovanni Corona

  16. University of Sheffield Medical School, Oncology and Metabolism, Sheffield, UK

    T. H. Jones & Hugh Jones

  17. Istanbul University, Urology, Istanbul, Turkey

    A. Kadioglu & Ateş Kadıoğlu

  18. Hospital Universitario Puerta de Hierro-Majadahonda, Urology, Madrid, Spain

    J. I. Martinez-Salamanca & J. I. Martínez Salamanca

  19. Biruni University, Urology, Istanbul, Turkey

    E. C. Serefoglu & Ege Can Şerefoğlu

  20. University of Naples Federico II, Urology, Naples, Italy

    P. Verze & Paolo Verze

  21. Imperial Healthcare NHS Trust, Charing Cross Hospital, Urology, London, UK

    S. Minhas & Suks Minhas

  22. URI-Urological Research Institute, Experimental Oncology/Unit of Urology, Milan, Italy

    A. Salonia & Andrea Salonia

  23. University Vita-salute San Raffaele, Milan, Italy

    A. Salonia

  24. Department of Medical and Surgical Sciences, Policlinico Riuniti, University of Foggia, Foggia, Italy

    Carlo Bettochi

  25. Department of Urology, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy

    Marco Falcone

  26. Department of Urology, Martha-Maria Hospital, Nuremberg, Germany

    Georgios Hatzichristodoulou

  27. Siloah St. Trudpert Klinikum, Pforzheim, Germany

    Georgios Hatzichristodoulou

  28. Department of Urology, Technical University of Munich, Munich, Germany

    Georgios Hatzichristodoulou

  29. Department of Urology, Centro Hospitalar São João, Porto, Portugal

    Afonso Morgado

  30. Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK

    Karen Czeloth

  31. Chelsea and Westminster Hospital NHS Foundation Trust, London, UK

    Michael Ager

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Consortia

on behalf of the EAU Working Group on Sexual and Reproductive Health

  • Andrea Salonia
  • , Suks Minhas
  • , Carlo Bettochi
  • , Giovanni Corona
  • , J. I. Martínez Salamanca
  • , Ateş Kadıoğlu
  • , J. P. Pereira de Carvalho
  • , Hugh Jones
  • , Paolo Verze
  • , Ege Can Şerefoğlu
  • , Paolo Capogrosso
  • , Luca Boeri
  • , Andrea Cocci
  • , Konstantinous Dimitropoulos
  • , Marco Falcone
  • , Murat Gül
  • , Georgios Hatzichristodoulou
  • , Arif Kalkanli
  • , Uros Milenkovic
  • , Afonso Morgado
  • , Giorgio Ivan Russo
  • , Tharu Tharakan
  • , Karen Czeloth
  •  & Michael Ager

Contributions

MG, LB, KD, SM, and AS: Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results. MG, SM, and AS: Drafted or revised the manuscript: SM and AS. Approved the final version. MG, LB, KD, PC, UM, AC, RV, GH, VM, GIR, TT, AK, MIO, CB, JC, GC, THJ, AK, JIM-S, ECS, PV, SM, AS: Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to A. Salonia.

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Gül, M., Luca, B., Dimitropoulos, K. et al. What is the effectiveness of surgical and non-surgical therapies in the treatment of ischemic priapism in patients with sickle cell disease? A systematic review by the EAU Sexual and Reproductive Health Guidelines Panel. Int J Impot Res 36, 20–35 (2024). https://doi.org/10.1038/s41443-022-00590-4

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  • DOI: https://doi.org/10.1038/s41443-022-00590-4

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