A systematic review of COVID-19 and priapism

Malinga, Dominic Mpumelelo
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Background: Coronavirus Disease 2019 (COVID-19) has an established impact on multiple organ systems including the vascular and urogenital systems. Vascular effects may include venous thromboembolic disease, which in theory may be a precursor to priapism, a urological emergency defined as an abnormal condition of prolonged penile erection of more than 4 hours in duration. To better explore this association, we have critically appraised all published COVID19 cases associated with priapism. Methods: After PROSPERO registration (CRD42021245257), a systematic search of Google Scholar, Scopus, Embase, Web of Science, PubMed, Cumulative Index to Nursing and Allied Health Literature, Global Index Medicus, and Cochrane Database of Systematic Reviews was performed using specific search terms. The following study metadata were extracted: age, requirement for respiratory support, cavernous blood gas findings, management of priapism, and patient outcomes. Results: Fifteen single-patient case reports were included in this review. Of these, all of the patients presented with ischemic priapism, nine (60.0%) were >60 years of age, four (28.6%) reported more than a single episode of priapism, 11 (73.3%) presented with pneumonia, eight (53.3%) required mechanical ventilation, D-dimer was elevated in five of the six (83.3%) patients in whom this was reported, and four (26.7%) patients died. Conclusion: Early reports suggest a prognostic relationship between COVID-19 and coexisting priapism. However, owing to commonalities in their pathophysiology and the small dataset reported in the literature, the probable association between COVID-19 and priapism is still theoretical. Further research is needed to confirm this association.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Science in Medicine to the Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg, 2022