Sickle cell disease: stuttering priapism was stopped by stilbestrol.

Clinical bottom line (level 1b)

  1. Patients with sickle cell disease and more than two attacks of stuttering priapism a week who were given stilbestrol, were less likely to have continuing attacks, than those given placebo (NNT = 1 at 2 weeks) .
Sergeant et al: Lancet 1985; 2: 1274-1276
Expires February 2003

The study

Double-blinded ?concealed randomised cross-over trial without intention-to-treat
Setting: sickle cell clinics, Jamaica

11 patients (aged range 18 to 59 years; mean 24, 100% male) homozygous sickle cell disease with attacks of stuttering priapism (at least two episodes a week)
Control Group: (n = 5, 5 analysed): placebo ( calcium lactate ) po once daily for two weeks
Experimental Group: (n = 9, 9 analysed): stilbestrol 5 mg po once daily for two weeks
Patients were crossed over to the other medication only if the original drug had no effect after two weeks.
100% followed for 30 days

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
continuing attacks of stuttering priapism 2 weeks 4
(80.0%)		 0
(0.00%)		 100%
(% to %)		 80.0%
(44.9% to 115%)		 1
(1 to 2)

  • In 5 of the 9 responders, attacks resumed within 2-8 weeks after cessation of therapy.

    • Comments

    1. Stuttering priapism can lead on to a major episode of priapism and subsequent impotence.

    Citation

    1. Sergeant GR, de Ceulaer K, Maude GH: Stilbestrol and stuttering priapism in homozygous sickle-cell disease. Lancet 1985; 2: 1274-1276
    Contributor: Chris Ball and Clare Wotton, February 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell disease
    Intervention or Exposure stilbestrol
    Comparison placebo
    Outcome continuing stuttering priapism attacks