A 24-year-old male with a history of sickle cell disease presents to the emergency department with a painful, rigid erection that has persisted for five hours despite a lack of sexual stimulation. Which of the following conditions is the most likely diagnosis?
Paraphimosis
Epididymitis
Testicular torsion
Priapism
The correct diagnosis is priapism, which is a persistent, painful erection lasting longer than four hours without sexual stimulation. It is considered a urological emergency. Ischemic priapism, the most common type, is frequently associated with sickle cell disease. Testicular torsion typically presents with acute, unilateral scrotal pain and a high-riding testis, not a prolonged erection. Epididymitis involves inflammation of the epididymis, causing scrotal pain, swelling, and tenderness, but not priapism. Paraphimosis is a condition where the foreskin is trapped behind the glans penis and cannot be reduced, which is a different clinical presentation.
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