In the Journals

Avoidance of Palpable Corporal Fibrosis Due to Priapism with Upregulators of Nitric Oxide.

Authors: Jacob Rajfer, John L. Gore, Jeffrey Kaufman, and Nestor Gonzalez-Cadavid

Journal: Journal of Sexual Medicine 2006; 3: 173-176

Editorial Comment: The authors report the use of an anti-scarring drug treatment to reduce the effects of post-priapism penile tissue scarring. The localized cavernosal low blood flow state and subsequent, erectile tissue scarring with eventual erectile dysfunction (ED) following untreated priapism is a real challenge for doctors and patient alike. Based on results in animal studies, Rajfer et al describe two cases with longstanding refractory priapism that were treated with L-arginine, pentoxyfylline, and sildenafil (Viagra) as anti-scarring agents. The same group had previously demonstrated these anti-scarring effects in the Peyronie's disease plaque tissue. In both of the described cases (6 month follow-up and 1 year follow up respectively), the erectile bodies remained soft to examination and long-term scarring was avoided. The reader is cautioned about the experimental nature of the described observations and the obvious limitations of a very small study in an uncommon disease. The authors also note that since on-demand use of PDE5 inhibitors (Viagra, Levitra, Cialis) for ED has been associated with a few reported cases of priapism, caution must be exercised when using PDE5 inhibitors in the recurrent priapism population. Nonetheless, this is an important report that sheds light on yet another possible application of PDE5 inhibitors.

Gregory A Broderick, M.D.