Priapism in the paediatric and adolescent population

Sickle cell disease is the leading cause of priapism in boys, and delayed treatment risks permanent erectile dysfunction

Journal: International Journal of Impotence Research | Published: 2024-11-25 | Type: Journal Article, Review | PMID: 39587254 Authors: Mushtaq Anah (Maidstone and Tunbridge Wells NHS Trust); Jayasimha Sudhindra, To Wilson King Lim, Mushtaq Imran (Great Ormond Street Hospital for Children NHS Trust) Funding/COI: No funding listed; authors declare no competing interests

Summary

This is a narrative review summarizing existing literature on priapism, a penile erection lasting over 4 hours unrelated to sexual stimulation, in children and adolescents. The authors report an overall incidence of 0.3-1.5 cases per 100,000 males annually across all ages, with sickle cell disease as the dominant cause in the pediatric population, typically producing the ischaemic subtype. The paper's central clinical point is that ischaemic priapism is a true emergency, and untreated or delayed cases lead to erectile dysfunction.

Claims

• Priapism incidence: 0.3-1.5 per 100,000 males per year, all ages combined
• Three subtypes described: ischaemic, non-ischaemic, and stuttering priapism
• Sickle cell disease is identified as the most common cause of priapism in children, usually presenting as the ischaemic subtype
• Ischaemic priapism is classified as a urological emergency requiring prompt diagnosis
• Erectile dysfunction is described as the primary long-term consequence of delayed management

Study Quality

This is a narrative review, not a systematic review or meta-analysis, and the abstract gives no indication of a defined search strategy, inclusion criteria, or PRISMA-style methodology. No original patient data, sample sizes, or effect sizes are reported since the paper synthesizes prior literature rather than generating new findings. The incidence figure (0.3-1.5 per 100,000/year) is presented without a cited source study, denominator population, or geographic scope in the abstract, making it impossible to assess how current or how broadly applicable that number is.

Without a stated methodology for how literature was selected, readers can't evaluate whether the review is comprehensive or cherry-picked, and the claim that erectile dysfunction is "the main consequence" of delayed treatment isn't accompanied by an incidence rate or supporting citation in the abstract.

Red Flags

• No systematic methodology described (search terms, databases, date range, inclusion/exclusion criteria)
• No sample size or patient count, since this is a literature synthesis rather than a primary study
• Incidence statistic (0.3-1.5 per 100,000/year) lacks a traceable source within the abstract
• No quantification of how often delayed management actually leads to erectile dysfunction
• Authors' institutional affiliations (specialist pediatric urology center) mean the review reflects a single-institution perspective on management pathways

Strengths

• Written by authors with direct pediatric urology and general surgery clinical experience at a major children's hospital
• Addresses a genuine gap: most priapism literature centers on adult populations, and pediatric-specific management pathways are less consolidated
• No funding or competing interests, reducing concern about commercial influence on treatment recommendations
• Focuses on an actionable clinical distinction (ischaemic vs. non-ischaemic) that matters for triage timing

Verdict

This is a standard narrative review with clinical utility for practitioners but limited value as an evidence source: it aggregates existing knowledge rather than testing a hypothesis, and the abstract offers no way to trace its central incidence figure back to primary data. Worth a skim if you want a clinician's-eye summary of pediatric priapism management, not worth citing as evidence for any specific numeric claim without pulling the full text and checking the primary sources it draws from.