Presentations Due to Priapism in an Urban Hospital in Switzerland

Priapism, a persisting erection not associated with sexual stimulation, can be ischaemic, with the risk of permanent erectile dysfunction, or nonischaemic. Drugs-e.g., injection therapies for erectile dysfunction, as well as neuroleptics, antidepressants and various other medicines-can also cause priapism. This study aimed to describe presentations due to priapism and provide insights into specific causes, clinical presentations, diagnostic strategies and emergency management.

A single-centre, retrospective, observational study of patients (≥ 16 years old) presenting to the University Hospital of Bern, Switzerland, between January 2010 and June 2023 due to priapism. The cases were retrieved from the electronic health records using full-text search.

During the study period, 40 cases corresponding to 32 patients were included. The mean ± SD age was 48 ± 15 years, and pain was present in 21 cases (53%) on presentation. Median time of erection was 15 h (range: 1-80, n = 23). A penile blood gas analysis was performed in 32 cases (80%), and 29 of these (91%) were of the low-flow type. Most commonly suspected causes were idiopathic (n = 25, 63%) and drug-induced (n = 10, 25%). Suspected agents in the drug-induced cases were corpus cavernosum autoinjection therapy (n = 4), trazodone (n = 3), sildenafil (n = 2) and urapidil (n = 1). Puncture of the corpus cavernosum and injection of noradrenalin and adrenalin were the therapeutic measure in 35 cases (88%). In 13 cases, there was at least one recurrence, including 10 within one week. Drugs given as recurrence prophylaxis included tadalafil (n = 9) and diazepam (n = 4).

Presentations due to priapism appear to be rare, but the majority of the cases presented with ischaemic priapism, which is a medical emergency. The findings can be used to identify areas requiring further research (e.g., drugs used as recurrence prophylaxis) and raise awareness of this potentially severe complication-which patients are often ashamed to report.