Recurrent Priapism After Living Donor Kidney Transplantation Requiring Bilateral T-Shunt Procedure: A Case Report

Priapism is a persistent penile erection lasting > 4 h without sexual stimulation. Ischemic priapism requires urgent management. We report a recurrent ischemic priapism case post-living-donor kidney transplantation necessitating multiple interventions, including bilateral T-shunt procedures.

A 44-year-old man with end-stage kidney disease from malignant nephrosclerosis and IgA nephropathy underwent living-donor kidney transplantation. On postoperative Day 5, priapism appeared upon catheter removal. Bedside corporal aspiration was initially performed. Recurrence prompted Winter's shunt on Day 6. Blood gas analysis confirmed ischemic priapism. On Day 7, further recurrence required bilateral T-shunts, resolving the condition. Propofol, used during anesthesia, was suspected as the cause. At the 6-month follow-up, priapism had not recurred, though erectile dysfunction developed.

This case highlights a rare but serious complication of kidney transplantation under general anesthesia, potentially linked to propofol. Timely escalation from aspiration to surgical shunting is crucial in persistent cases to prevent long-term sequelae.