What is included in long-term monitoring of priapism?

Updated: Dec 26, 2019
  • Author: Osama Al-Omar, MD, MBA, FACS, FEBU; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Ensure adequate follow-up care with a urologist if therapy in the ED is successful. Patients with identified underlying disorders should follow up with the appropriate specialist.

Some patients may have recurrent priapism. These patients may be prescribed a home supply of terbutaline. Instruct these patients on how to self-administer this medication either as a 5-mg tablet or a 0.25-0.5 mg subcutaneous injection prior to presentation.

Patients with sickle cell disease may also benefit from intramuscular leuprolide (Lupron) injections prescribed by a urologist. Leuprolide is a gonadotropin-releasing hormone (GnRH) agonist and thus should be avoided in patients who have not fully matured sexually. [7]

A small study (in 8 patients) describes suppression of testosterone with ketoconazole and prednisone for treatment of recurrent priapism. [34] In a more recent study involving 17 patients, starting ketoconazole at 200 mg 3 times daily and prednisone at 5 mg daily for 2 weeks, then tapering to ketoconazole 200 mg nightly for 6 months, proved reasonably effective, safe, and inexpensive. [35] This therapy should be initiated by a urologist because testosterone measurements may be necessary to monitor therapy.

Finasteride proved effective for preventing recurrent priapism in a study of 5 adolescents and children with sickle cell disease; most of these patients responded to a dosage of 1 mg a day. [36] Several other treatments have been reported with variable success rates, including phosphodiesterase-5 enzyme (PDE-5) inhibitors, antiandrogens, and other medications. [13, 36, 37, 38, 39]


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