Prevalence and Predictors of Priapism Among Patients with Sickle Cell Disease: A Cross-Sectional Study

Background and Objectives: Priapism, most commonly the ischemic (low-flow) type, is a debilitating complication affecting males with sickle cell disease (SCD), making prevention a critical aspect of care. This study aimed to determine the prevalence of priapism and identify its associated predictors among adult patients with SCD. Materials and Methods: This cross-sectional study was conducted at the Hereditary Blood Disorder Centre in the Eastern Province of Saudi Arabia from February 2024 to August 2025. Results: A total of 240 male SCD patients were included, of whom 33 (13.8%) reported a lifetime history of priapism. The median age at the first priapism episode was 29 years. Multivariate logistic regression identified a history of blood transfusion as the only significant independent predictor of priapism (aOR = 10.36, 95% CI: 1.32-81.14, p = 0.026). Episode frequency varied, with 33.3% of affected patients reporting episodes occurring monthly or less than weekly. Regarding timing, 45.5% of episodes occurred during sleep, while 27.3% occurred in the early morning hours. Kaplan-Meier survival curves indicated that patients receiving hydroxyurea experienced priapism at significantly younger ages compared with non-users (95% CI: 23-33 years). This difference was confirmed by a statistically significant log-rank test (p = 0.012), indicating a more rapid decline in the probability of remaining priapism-free with increasing age among hydroxyurea users. Conclusions: Priapism in SCD remains a significant clinical challenge despite available therapeutic options. Transfusion burden, alongside previously recognized predictors, serves as a key indicator of priapism risk and underscores the importance of early identification and intervention. Although hydroxyurea is effective in managing several complications of sickle cell disease, priapism was observed in patients despite its use, and episodes continued to occur with increasing age; however, these findings may be influenced by confounding factors such as age, disease severity, and transfusion history.