Editing Priapism (section)

===== Recurrent Ischemic Priapism =====
* '''Options''' '''to prevent subsequent episodes<span style="color:#ff0000">[https://pubmed.ncbi.nlm.nih.gov/35536142/ ★]</span>'''
**'''Idiopathic (7):'''
**#'''<span style="color:#ff0000">Ketoconazole with prednisone'''
**#*'''Highest success rate'''
**#*'''<span style="color:#ff0000">Adverse effects'''
**#*#'''<span style="color:#ff0000">Liver toxicity, thus warranting frequent assessment of liver function tests</span>'''
**#'''<span style="color:#ff0000">Pseudoephedrine</span>''', an oral α-adrenergic agonist, promotes muscle contraction within the erectile tissue
**#'''<span style="color:#ff0000">Phosphodiesterase type 5 inhibitors</span>'''
**#'''Aspirin'''
**#'''Baclofen'''
**#'''Dutasteride'''
**#'''Cyproterone acetate'''
**##Anti-androgen
**##Not available in the United States
**'''Associated with sickle cell disease'''
**#'''Same options as idiopathic'''
**#'''Etilefrine'''
**#'''Hydroxyurea'''
**#'''Automated exchange transfusion'''
**'''Drug therapy is typically initiated at bedtime'''
**Patients with recurrent ischemic priapism should be informed that hormonal regulators (ketoconazole, cyproterone acetate) may impair fertility and sexual function
***Adverse effects, due to manipulation of hypothalamic-pituitary-gonadal axis
****Fatigue
****Hot flashes
****Breast tenderness
****Changes in mood
****ED
****Negatively impact sperm parameters
**'''Home self-injection of intracavernous α-adrenergic agent'''
*** Not a preventative strategy; may avert a full-blown episode of ischemic priapism when administered at home for prolonged morning erections
**'''Optimal strategy is unknown'''