leuprolide and Priapism

High-flow priapism (HFP) may occur secondary to perineal trauma, congenital arterial malformations, and iatrogenic insults. In cases that do not resolve spontaneously, standard management is by selective embolization, resulting in resolution rates as high as 78%; however, erectile dysfunction (ED) is a frequent complication, occurring in up to 39% of cases.. We report our use of androgen blockade (AB) to suppress nocturnal erections as an alternative treatment for HFP.. A retrospective review of all patients treated at our institution for HFP was undertaken. Included in this study were any patients treated with single- or combination-agent AB for HFP. Operative reports and medical records were examined to determine patient characteristics and outcomes. Treatment efficacy, side effects, and residual ED were assessed using a questionnaire.. The primary clinical outcomes assessed were resolution of HFP, tolerability, and side effects of treatment.. Seven patients with HFP were treated with AB. Priapism was a result of trauma in three patients and a persistent high-flow state after shunt procedures in four. Mean follow-up was 2 years (range 4 to 64 months). Therapy consisted primarily of 7.5 mg intramuscular monthly leuprolide injections, although bicalutamide and ketoconazole were also utilized as adjunct treatments. Therapy duration ranged from 2 months to 6 months and was discontinued after symptom resolution. One patient discontinued daily ketoconazole after 1 week because of severe hot flashes. The remaining six patients reported complete resolution of HFP. The primary complaints during therapy were decreased libido and fatigue. All patients reported some degree of ED during therapy. There was no reported residual ED or other hypogonadal symptoms on withdrawal of therapy.. AB is a successful option for treating HFP with acceptable side effects and return to baseline potency on treatment withdrawal.

Topics: Adult; Androgen Antagonists; Androgens; Anilides; Antineoplastic Agents, Hormonal; Erectile Dysfunction; Humans; Ketoconazole; Leuprolide; Male; Middle Aged; Nitriles; Penile Erection; Priapism; Retrospective Studies; Surveys and Questionnaires; Tosyl Compounds; Ultrasonography; Young Adult

Recurring periods of prolonged erections in patients with sickle cell disease (stutter priapism) are uncommon, yet troubling sequelae of hemoglobinopathies. Medical or surgical therapy is variably successful in these men. We report a case of stutter priapism successfully treated with an oral antiandrogen.

Topics: Adult; Androgen Antagonists; Anemia, Sickle Cell; Flutamide; Gynecomastia; Headache; Humans; Leuprolide; Male; Mastectomy; Priapism; Radiotherapy; Treatment Outcome

A case of recurrent priapism in a young black man without sickle cell anemia is reported. Due to almost daily episodes of prolonged painful erections, the patient was instructed in intracorporeal injection using an epinephrine self-injection kit, which provided complete detumescence on 31 occasions. The patient refused surgical intervention and was treated with monthly intra-muscular gonadotropin-releasing hormone analogue. Priapism episodes completely abated by the second and final monthly gonadotropin-releasing hormone analogue injection without recurrence during 4 months of followup. Normal erectile function was maintained during and after gonadotropin-releasing hormone analogue therapy. Epinephrine self-injection and gonadotropin-releasing priapism.

Topics: Adult; Drug Therapy, Combination; Epinephrine; Humans; Injections, Intramuscular; Leuprolide; Male; Priapism; Recurrence; Self Administration

Priapism secondary to sickle cell anemia has been treated with a variety of therapeutic regimens. Recurrent sickle cell priapism is common and in many cases results when detumescence has not been achieved reliably. We report on a patient with sickle cell disease and recurrent priapism who was treated successfully for more than a year with monthly gonadotropin-releasing hormone analogue therapy after failure of standard medical management.

Topics: Adolescent; Anemia, Sickle Cell; Humans; Leuprolide; Male; Priapism; Recurrence