Erectile Dysfunction Rates and Associated Factors Due to Priapism in Adult Patients at the Kenyatta National Hospital

Abstract

Introduction: Priapism is prolonged penile tumescence for four or more hours that goes on past or is unassociated with sexual stimulation. It’s a urological emergency whose poor management can result in severe penile fibrosis, penile deformity, length loss and erectile dysfunction with substantial impact on quality of life. Therefore, understanding the rate and factors contributing to erectile dysfunction in patients managed for priapism can help formulate interventions aimed at reducing these rates. In Kenya and our region there is paucity of data regarding the erectile function outcomes following management for priapism. Objectives: To establish the pattern of priapism occurrence and the associated complications of erectile dysfunction (ED) in adult male patients at The Kenyatta National Hospital (KNH) between 2010 and 2020. Methodology: Using a cross-sectional study, 79 adult male patients managed for priapism between 2010 and 2020 at KNH urology clinic, urology ward and other medical wards were sampled and interviewed using IIEF-5 questionnaire to elaborate on the rate of Erectile dysfunction (ED) and associated factors. Data analysis: Descriptive statistics including mean, medians and proportions were run to describe the characteristics of the study participants and the rates of occurrence of ED after priapism. For hypothesis testing, Chi square was used to determine the association between categorical variables with Students T test for continuous variables. P-values <0.05 were regarded statistically significant. Results: Mean age was 30.4 years (SD 7.65, range 17 to 47) with majority (74.4%) having studied up to secondary. Seventy-seven (98.7%) of participants had ischemic priapism while only one had non-ischemic type. Median duration of symptoms prior to presentation was 72 hours with a mean of 112 hours (range 12 - 720). Priapism was mostly idiopathic in 21 (26.9%). Other causes significant included Chronic myeloid leukemia in 20 (25.6%), Sickle Cell Disease, 14 (18%), use of antipsychotics in 11 (14.1%) and Post-coital in 6 (7.7%). T-shunt (Lue) was mostly used for treatment in 51 (65.4%), followed by Winter, 13 (16.7%), Ebbehoj, 5 (6.4%), Aspiration, 5 (6.4%), Burnett, 2 (2.6%) and Conservative 2 (2.6%). The prevalence of ED after priapism was 100% as compared to 74.4% before priapism. However, ED occurred in varying categories after onset of priapism with majority 46 (59%) developing severe ED. Factors associated with occurrence of ED was duration of presentation p value 0.001 with longer duration associated with severity of ED and treatment method used with T-shunt, Winter, and Burnett being significant risk factors. Conclusion: This study found the prevalence of ED after priapism to be high in this population. Contributory factors were late presentation and treatment method used. There is need for public health awareness on the condition to inform patients on need for early presentation following a suspicion of the condition as well as use of methods of treatment least likely to contribute to ED. There is also a need to procure penile prosthesis and make them accessible to patients suffering ED following priapism.