(PNM-35) Recurrent priapism in a sickle cell disease patient treated with gonadotropin-releasing hormone (GnRH) agonists drugs: a case report

Abstract Objective Priapism is an uncommon yet critical urological emergency, especially in sickle cell disease (SCD) patients. If not adequately managed, recurrent episodes may lead to irreversible erectile dysfunction and reduced quality of life. This case report describes a clinical approach using advanced pharmacological therapy for a complex case of stuttering priapism. Material and Methods A 34-year-old male with SCD, under regular hematology follow-up, experienced 4 episodes of ischemic priapism in 4 months. Each episode required emergency intracavernosal irrigation with epinephrine. Despite optimized outpatient care—aspirin, hydroxyurea, finasteride, and monthly exchange transfusions—he reported daily painful erections. Oral etilefrine was ineffective after three months. Bicalutamide 50 mg/day caused painful gynecomastia and ongoing symptoms, leading to discontinuation. As a last attempt before penile prosthesis, goserelin, a GnRH agonist, was prescribed quarterly. Patient demonstrated marked clinical improvement. Stuttering priapism ceased, and he recovered satisfactory erectile function. Consequently, he chose to continue hormonal therapy rather than undergoing penile prosthesis implantation. A multidisciplinary follow-up was arranged, including cardiology, to assess potential adverse effects from long-term GnRH agonist use and monitor ongoing therapeutic response. Results Gonadotropin-releasing hormone (GnRH) agonists, as others hormonal regulators, has demonstrated symptomatic relief and improvement in quality of life, accordingly with latest AUA and EAU guidelines. Although, further studies need to be conducted aiming a long term safety knowledge, which remains unknown. Conclusion Recurrent priapism in patients with sickle cell disease remains a therapeutic challenge. Goserelin proved effective as a last-line treatment, offering symptom control and functional improvement while surgical intervention was delay. Financing No conflict.