Delayed hypertensive crisis after intracavernosal phenylephrine for penile plication

Intracavernosal phenylephrine injection is commonly used during penile plication for Peyronie's disease due to its desirable vasoconstrictive effect in achieving detumescence. Although systemic absorption of medications following intracavernosal administration may occur, high-dose intracavernosal phenylephrine has been reported to be safe and effective in treating priapism with a rare incidence of morbidity or significant haemodynamic changes. We describe a 68-year-old man who underwent ambulatory penile plication with intra-operative intracavernosal phenylephrine injection, which led to hypertensive emergency 90 min postoperatively. This case highlights the potential for delayed-onset haemodynamic changes following intra-operative intracavernosal phenylephrine injection and the need for judicious monitoring postoperatively.