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Roche et al

Roche et al discuss impossible

Etilephrine has been used successfully to prevent stuttering priapism due to sickle cell anaemia. In one randomised placebo-controlled clinical study looking at medical prophylaxis with etilephrine and ephedrine, there was no difference in efficacy between the two drugs.

All approaches have a similar efficacy profile (LE: 4) while the potential cardiovascular toxicity of oestrogens limits their clinical use. Of the hormonal agents suggested for preventing priapism, GnRH agonists and anti-androgens appear to be the most efficacious and safe. They are recommended as primary treatments for the management of stuttering priapism in adult men (LE: 4).

The duration of hormonal treatment for effective suppression of recurrent priapism events is problematic. It is not possible to make any conclusions on the efficacy, dose and the duration of treatment. Moreover, hormonal agents have a contraceptive effect and interfere roche et al normal sexual maturation and spermatogenesis.

Caution is therefore strongly advised when prescribing hormonal treatments to pre-pubertal boys, adolescents roche et al men who are trying with their female partner to conceive. Digoxin (a cardiac glycoside and a positive inotrope) is used to treat patients with congestive heart failure. The roche et al of maintenance digoxin doses (0. Side-effects may include a decreased libido, anorexia, nausea, vomiting, confusion, blurred vision, headache, gynaecomastia, rash and arrhythmia.

Side-effects include nervousness, shakiness, drowsiness, heart palpitations, headache, dizziness, hot flashes, nausea and weakness. Gabapentin has anticonvulsant, antinociceptive and anxiolytic properties roche et al is widely used as an analgesic and antiepileptic agent.

Baclofen is a gamma-aminobutyric acid (GABA) schizophrenia catatonic that acts as a muscle relaxant and anti-muscle spasm agent. Side-effects include drowsiness, confusion, dizziness, weakness, fatigue, headache, hypotension and nausea.

Side-effects include oligozoospermia and leg ulcers. It roche et al important to remember that therapy should be started when the penis is in its flaccid state and not during an acute episode. There is a delay of one week before treatment is effective.

Side-effects include hypertension, coronary ischaemia and cardiac arrhythmias. Tissue plasminogen activator (TPA) is a secreted serine protease that converts the pro-enzyme plasminogen to plasmin, which acts as a fibrinolytic enzyme. Mild bleeding roche et al the most commonly observed side-effect. The primary goal in the management of patients with stuttering priapism is the prevention of future episodes, which can generally be achieved pharmacologically.

PDE5Is have a paradoxical effect in alleviating and preventing stuttering priapism, mainly in roche et al with idiopathic and sickle cell disease associated priapism.

Manage each acute episode roche et al to that for ischaemic priapism. Do not use them before sexual roche et al is reached. Initiate treatment atv phosphodiesterase type 5 inhibitors only when the penis is in its flaccid state. Use intracavernous self-injections at home of sympathomimetic drugs for roche et al treatment of acute episodes on an interim basis until ischaemic priapism has been alleviated.

This document was developed with the financial support of the European Association of Urology. No external sources of funding and support have been involved.

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