Stuttering priapism after laparoscopic radical prostatectomy: A case report

Abstract

A 66-year-old man presented with voiding symptoms, a serum prostate-specific antigen (PSA) of 7.24 ng/ml, a benign-feeling prostate and normal erections. His medical history included chronic obstructive pulmonary disease (COPD). Trans-rectal ultrasound-guided biopsy revealed Gleason 4+3 prostate adenocarcinoma. Staging magnetic resonance imaging (MRI) scan illustrated bilateral disease, T2c pN0 M0 (Figure 1). He underwent a laparoscopic radical prostatectomy two months later with a trans-peritoneal approach and bilateral nerve spare. Histology revealed pT3a Gleason 4+3 disease with negative margins. At 14 days he presented with spontaneous moderately painful erections every two hours without sexual stimulation along with urinary tract infection. Examination was normal. Urine microscopy and culture revealed an extended spectrum beta lactamase (ESBL)producing E. coli organism, and antibiotic treatment was commenced. By day 28, his erections occurred mainly in association with voiding and straining. A computed tomography (CT) scan identified an organised haematoma in the prostatic bed (Figure 2), and a flexible cystoscopy revealed complete closure of the proximal urethra so a suprapubic catheter was inserted. His stuttering erections fully resolved and the haematoma was managed conservatively. He underwent a delayed optical urethrotomy. At six months, his PSA level was un-recordable. He reported improved continence and partial return of sexual function. Stuttering priapism after laparoscopic radical prostatectomy: A case report