Abstract
Priapism is a prolonged, unintended erectile state unrelated to sexual dysfunction or sexual desire. There are three types of priapism, determined by penile artery blood flow:ischemic, non-ischemic, and recurrent. It could be secondary to hematologic disorders, infections, metabolic disorders, or neoplasms and may be idiopathic or medication induced. Here we describe a case of a-blocker induced priapism. A 52-year-old male with no known medical history presented with lower urinary tract symptoms(LUTS). On exam he was found to have a grade 1 prostate enlargement.Labs revealed PSA 1.3 ng/mL, creatinine 0.9 mg/dL, and BUN 35mg/dL, Hb: 13,5 g/dL, mcv: 87 fL.Uroflowmetry was consistent with obstruction with qmax 8.7ml/s and urinary US with prostate measuring 60cc, post-voidal residual volume(PVR) 120cc. He was started on silodosin 8mg 1*1 for benign prostate hyperplasia(BPH) treatment. After a week, he presented back with a 48-hour unintended erection. Exam was consistent with priapism and emergent penile US showed decreased penile blood. Despite undergoing emergent corpus cavernosum aspiration and 0.01% adrenalin irrigation, tumescence persisted requiring corpus cavernosum deep venous shunt with reversion of the prolonged erection on post-op follow. By his follow-up, patient had developed erectile dysfunction. Subsequently, he planned to undergo penile prothesis. (Before using alpha blocker IIEF-5 score: 21; 3month IIEF-5 score: 8)
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