Page 109 - Remedial Andrology

Table 32: Aetiological factors for the development of priapism

Idiopathic Haematological Infections Metabolic Neurogenic Neoplasms Medications
dyscrasias (toxin- disorders disorders (metastatic
Vascular and mediated) or regional
other disorders infiltration)
- SCD, - scorpion - amyloidosis, - syphilis, - prostate, - Vasoactive erectile
- thalassemia, sting, - Fabry’s - spinal cord - urethra, agents (i.e., papaverine,
- leukaemia; - spider disease, injury, - testis, phentolamine,
- multiple myeloma, bite, - gout - cauda equina - bladder, prostaglandin E1/
- haemoglobin - rabies, syndrome, - rectal, alprostadil, combination
Olmsted variant, - malaria - autonomic - lung, of intracavernous
- fat emboli during neuropathy, - kidney therapies)
hyperalimentation, - lumbar disc - α-adrenergic receptor
- haemodialysis, herniation, antagonists (i.e., prazosin,
- glucose-6- - spinal stenosis, terazosin, doxazosin and
phosphate - cerebrovascular tamsulosin)
dehydrogenase accident, - Anti-anxiety agents
deficiency, - brain tumour, (hydroxyzine)
- factor V Leiden - spinal - Anticoagulants (heparin
mutation anaesthesia and warfarin)
- vessel vasculitis - Antidepressants and
(e.g., Henoch- antipsychotics (i.e.,
Schönlein trazodone, bupropion,
purpura; Behçet’s fluoxetine, sertraline,
disease; anti- lithium, clozapine,
phospholipid risperidone, olanzapine,
antibodies chlorpromazine,
syndrome) thiorizadine,
phenothiazines and
methylphenidate)
- Antihypertensives (i.e.,
hydralazine, guanethidine
and propranolol)
- Hormones (i.e.,
gonadotropin-
releasing hormone and
testosterone)
- Recreational drugs (i.e.,
alcohol, marijuana,
cocaine [intranasal and
topical], and crack,
cocaine)

9.1.1.1 Summary of evidence on the epidemiology, aetiology and pathophysiology of ischaemic priapism

Summary of evidence LE
Ischaemic priapism is the most common type, accounting for more than 95% of all cases. 1b
Ischaemic priapism is identified as idiopathic in most patients, while sickle cell disease is the most 1b
common cause in childhood.
Ischaemic priapism occurs relatively often (about 5%) after intracavernous injections of papaverine- 2a
based combinations, while it is rare (< 1%) after prostaglandin E1 monotherapy.
Priapism is rare in men who have taken Phosphodiesterase Type 5 Inhibitors, with only sporadic cases 4
reported.

108 SEXUAL AND REPRODUCTIVE HEALTH - MARCH 2021