Kirakoya Brahima, Yameogo Clotaire, Ziba Ouima Justin Dieudonné, Idogo Ouedan, Sawadogo Hassami, Kaboré Fasnéwindé Aristide
Treatment delay beyond 48 hours is the primary independent predictor of erectile dysfunction following ischemic priapism, regardless of patient characteristics or treatment modality. These findings underscore the urgent need for patient education and improved access to emergency urological care in sub-Saharan Africa.
BACKGROUND: Ischemic priapism is a time-sensitive urological emergency with significant consequences for erectile function. Real-world data from low-resource sub-Saharan settings, where delayed presentation is common, remain scarce.
OBJECTIVE: To determine outcomes of ischemic priapism management and to identify predictive factors for erectile dysfunction after treatment.
METHODS: Retrospective cross-sectional study conducted at the Urology Department of CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso (January 2019-December 2022). Consecutive patients aged ≥15 years with ischemic priapism were included. Erectile function was assessed using the International Index of Erectile Function 6-item version (IIEF-6), a validated 6-item questionnaire scored from 1 to 30, with scores ≥26 indicating no erectile dysfunction. IIEF-6 was recorded at diagnosis (recalled by the patient) and at last follow-up. Patients were stratified by treatment delay (<24 h, 24-48 h, >48 h). Multivariate logistic regression identified independent predictors of erectile dysfunction.
RESULTS: Of 58 patients admitted, 41 were included (mean age 31.2 ± 8.9 years). Sickle cell hemoglobinopathies (SS and SC genotypes) were identified in 46.3% of cases. The mean consultation delay was 85.3 hours. The mean IIEF-6 score declined significantly from 28.6 pre-event to 16.7 post-treatment (p<0.001). Only 29.3% of patients retained erectile function sufficient for intercourse. In multivariate analysis, treatment delay >48 hours was the sole independent predictor of erectile dysfunction (adjusted OR = 13.7; 95% CI: 2.4-76.4; p = 0.0005).
CONCLUSION: Treatment delay beyond 48 hours is the primary independent predictor of erectile dysfunction following ischemic priapism, regardless of patient characteristics or treatment modality. These findings underscore the urgent need for patient education and improved access to emergency urological care in sub-Saharan Africa.