How I manage priapism in chronic myeloid leukaemia patients

Priapism is a rare presenting feature of chronic myeloid leukaemia (CML). It is a urological emergency requiring urgent treatment to prevent long-term complications, in particular erectile dysfunction. In males with CML, ischaemic priapism is believed to result from hyperleucocytosis and associated leucostasis or hyperviscosity, and is seen in patients presenting with a high white cell count. Increasingly, a combined modality approach is being used to treat CML patients presenting with priapism. This includes systemic therapy with chemotherapy (hydroxycarbamide or tyrosine kinase inhibitors) and therapeutic leukapheresis to reduce the white cell count as well as local intracavernous therapy. This review will examine the literature and discuss the presenting features, investigations and management of priapism in CML.