A Rare Case of Severe Idiopathic Stuttering Priapism in a Young Healthy Man

Priapism, a persistent erection of the penis which has no association with sexual activity and lasts longer than four hours, is a urologic emergency. It can be classified into ischemic, nonischemic, and stuttering categories. The pathophysiology of stuttering priapism is not well understood; however, the dysregulation of nitric oxide and phosophodiesterase-5 (PDE5) has been put forward as a possible mechanism. A 35-year-old male with a history of recurrent priapism presented with continuous penile erection for more than 48 hours. In the emergency room, penile aspiration and an intracavernous phenylephrine injection were attempted which did not help. Subsequently, a distal penile shunt was surgically created; however, the patient's symptoms still persisted. A second round of penile irrigation, aspiration, and an intracavernous phenylephrine injection were attempted, but it was not helpful. Finally, another surgical shunt was created bilaterally between the corpora cavernosa and corpus spongiosum, which led to complete resolution of symptoms in the next 24 hours. The patient received an injection of lupron, and he was discharged.