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Is testosterone deficiency a possible risk factor for priapism associated with sickle-cell disease?

  • Urology - Original Paper
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Abstract

Purpose

The purpose of this study was to determine the association of testosterone deficiency and priapism in adult men with sickle cell disease (SCD).

Methods

A cross-sectional study of 50 adult men with SCD (hemoglobin SS) was performed. All patients had early morning blood taken for total and free testosterone, FSH, LH, prolactin, lipid levels, LDH and hematological indices. Patients completed an interviewer-administered questionnaire regarding priapism frequency, duration and treatment. Testosterone deficiency was defined as a serum total testosterone <12 nmol/L (346 ng/dL).

Results

The mean age of the study population was 34.2 ± 8.9 years. Priapism was noted in 24 (48 %) patients and was most frequently seen in men between ages 18–25 years. Testosterone deficiency was observed in 11 of the 50 (22 %) patients, particularly in 6 of 24 (25 %) patients with histories of priapism. There was no difference in mean total testosterone levels in patients with and without a history of priapism (16.7 ± 4.9 nmol/L and 15.4 ± 5.9 nmol/L, respectively) (p = 0.43). Similarly, there was no difference in serum LH and FSH levels based on history of priapism.

Conclusion

Testosterone deficiency is prevalent in patients with SCD; however, we did not identify an association based on a history of priapism. Larger, prospectively gathered data are needed to define the priapism profile of SCD patients with testosterone deficiency.

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References

  1. Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, Nehra A, Sharlip ID (2003) American Urological Association guideline on the management of priapism. J Urol 170(4 Pt 1):1318–1324

    Article  PubMed  Google Scholar 

  2. Emond AM, Holman R, Hayes RJ, Serjeant GR (1980) Priapism and impotence in homozygous sickle cell disease. Arch Intern Med 140(11):1434–1437

    Article  CAS  PubMed  Google Scholar 

  3. Pryor J, Akkus E, Alter G, Jordan G, Lebret T, Levine L, Mulhall J, Perovic S, Ralph D, Stackl W (2004) Priapism. J Sex Med 1(1):116–120

    Article  PubMed  Google Scholar 

  4. Osegbe DN, Akinyanju OO (1987) Testicular dysfunction in men with sickle cell disease. Postgrad Med J 63(736):95–98

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Parshad O, Stevens MC, Preece MA, Thomas PW, Serjeant GR (1994) The mechanism of low testosterone levels in homozygous sickle-cell disease. West Indian Med J 43(1):12–14

    CAS  PubMed  Google Scholar 

  6. Dada OA, Nduka EU (1980) Endocrine function and haemoglobinopathies: relation between the sickle cell gene and circulating plasma levels of testosterone, luteinising hormone (LH) and follicle stimulating hormone (FSH) in adult males. Clin Chim Acta 105(2):269–273

    Article  CAS  PubMed  Google Scholar 

  7. Singhal A, Gabay L, Serjeant GR (1995) Testosterone deficiency and extreme retardation of puberty in homozygous sickle-cell disease. West Indian Med J 44(1):20–23

    CAS  PubMed  Google Scholar 

  8. Modebe O, Ezeh UO (1995) Effect of age on testicular function in adult males with sickle cell anemia. Fertil Steril 63(4):907–912

    CAS  PubMed  Google Scholar 

  9. Traish A, Kim N (2005) The physiological role of androgens in penile erection: regulation of corpus cavernosum structure and function. J Sex Med 2(6):759–770

    Article  CAS  PubMed  Google Scholar 

  10. Morelli A, Filippi S, Mancina R, Luconi M, Vignozzi L, Marini M, Orlando C, Vannelli GB, Aversa A, Natali A, Forti G, Giorgi M, Jannini EA, Ledda F, Maggi M (2004) Androgens regulate phosphodiesterase type 5 expression and functional activity in corpora cavernosa. Endocrinology 145(5):2253–2263

    Article  CAS  PubMed  Google Scholar 

  11. Slayton W, Kedar A, Schatz D (1995) Testosterone induced priapism in two adolescents with sickle cell disease. J Pediatr Endocrinol Metab 8(3):199–203

    Article  CAS  PubMed  Google Scholar 

  12. Lundh B, Gardner FH (1970) The haematological response to androgens in sickle cell anaemia. Scand J Haematol 7(5):389–397

    Article  CAS  PubMed  Google Scholar 

  13. Serjeant GR, de Ceulaer K, Maude GH (1985) Stilboestrol and stuttering priapism in homozygous sickle-cell disease. Lancet 2(8467):1274–1276

    Article  CAS  PubMed  Google Scholar 

  14. Costabile RA (1998) Successful treatment of stutter priapism with an antiandrogen. Tech Urol 4(3):167–168

    CAS  PubMed  Google Scholar 

  15. Abern MR, Levine LA (2009) Ketoconazole and prednisone to prevent recurrent ischemic priapism. J Urol 182(4):1401–1406

    Article  CAS  PubMed  Google Scholar 

  16. Kato GJ, McGowan V, Machado RF, Little JA, Taylor J, Morris CR, Nichols JS, Wang X, Poljakovic M, Morris SM Jr, Gladwin MT (2006) Lactate dehydrogenase as a biomarker of hemolysis-associated nitric oxide resistance, priapism, leg ulceration, pulmonary hypertension, and death in patients with sickle cell disease. Blood 107(6):2279–2285

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Saad F, Gooren LJ (2011) The role of testosterone in the etiology and treatment of obesity, the metabolic syndrome, and diabetes mellitus type 2. J Obes 2011:1–10

  18. Wu FC, Tajar A, Beynon JM, Pye SR, Silman AJ, Finn JD, O’Neill TW, Bartfai G, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean ME, Pendleton N, Punab M, Boonen S, Vanderschueren D, Labrie F, Huhtaniemi IT (2010) Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 363(2):123–135

    Article  CAS  PubMed  Google Scholar 

  19. Seo SI, Kim SW, Paick JS (1999) The effects of androgen on penile reflex, erectile response to electrical stimulation and penile NOS activity in the rat. Asian J Androl 1(4):169–174

    CAS  PubMed  Google Scholar 

  20. Burnett AL, Lowenstein CJ, Bredt DS, Chang TS, Snyder SH (1992) Nitric oxide: a physiologic mediator of penile erection. Science 257(5068):401–403

    Article  CAS  PubMed  Google Scholar 

  21. Bivalacqua TJ, Musicki B, Kutlu O, Burnett AL (2012) New insights into the pathophysiology of sickle cell disease-associated priapism. J Sex Med 9(1):79–87

    Article  CAS  PubMed  Google Scholar 

  22. Traish AM, Park K, Dhir V, Kim NN, Moreland RB, Goldstein I (1999) Effects of castration and androgen replacement on erectile function in a rabbit model. Endocrinology 140(4):1861–1868

    CAS  PubMed  Google Scholar 

  23. Meusburger SM, Keast JR (2001) Testosterone and nerve growth factor have distinct but interacting effects on structure and neurotransmitter expression of adult pelvic ganglion cells in vitro. Neuroscience 108(2):331–340

    Article  CAS  PubMed  Google Scholar 

  24. Champion HC, Bivalacqua TJ, Takimoto E, Kass DA, Burnett AL (2005) Phosphodiesterase-5A dysregulation in penile erectile tissue is a mechanism of priapism. Proc Natl Acad Sci USA 102(5):1661–1666

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Bivalacqua TJ, Liu T, Musicki B, Champion HC, Burnett AL (2007) Endothelial nitric oxide synthase keeps erection regulatory function balance in the penis. Eur Urol 51(6):1732–1740

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Yuan J, Desouza R, Westney OL, Wang R (2008) Insights of priapism mechanism and rationale treatment for recurrent priapism. Asian J Androl 10(1):88–101

    Article  CAS  PubMed  Google Scholar 

  27. Mi T, Abbasi S, Zhang H, Uray K, Chunn JL, Xia LW, Molina JG, Weisbrodt NW, Kellems RE, Blackburn MR, Xia Y (2008) Excess adenosine in murine penile erectile tissues contributes to priapism via A2B adenosine receptor signaling. J Clin Invest 118(4):1491–1501

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Kanika ND, Tar M, Tong Y, Kuppam DS, Melman A, Davies KP (2009) The mechanism of opiorphin-induced experimental priapism in rats involves activation of the polyamine synthetic pathway. Am J Physiol Cell Physiol 297(4):C916–C927

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Morrison BF, Reid M, Madden W, Burnett AL (2013) Testosterone replacement therapy does not promote priapism in hypogonadal men with sickle cell disease: 12-month safety report. Andrology 1(4):576–582

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, University of the West Indies, Mona, Jamaica

    Belinda F. Morrison

  2. Sickle Cell Unit, University of the West Indies, Mona, Jamaica

    Marvin E. Reid & Wendy A. Madden

  3. The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine, Baltimore, MD, 21287-2101, USA

    Uzoma A. Anele, Zhaoyong Feng & Arthur L. Burnett

Authors
  1. Belinda F. Morrison
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  2. Uzoma A. Anele
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  3. Marvin E. Reid
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  4. Wendy A. Madden
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  5. Zhaoyong Feng
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  6. Arthur L. Burnett
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Corresponding author

Correspondence to Arthur L. Burnett.

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Morrison, B.F., Anele, U.A., Reid, M.E. et al. Is testosterone deficiency a possible risk factor for priapism associated with sickle-cell disease?. Int Urol Nephrol 47, 47–52 (2015). https://doi.org/10.1007/s11255-014-0864-1

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  • DOI: https://doi.org/10.1007/s11255-014-0864-1

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