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Priapism associated with concurrent use of phosphodiesterase inhibitor drugs and intracavernous injection therapy

International Journal of Impotence Research volume 15, pages 383–384 (2003)Cite this article

The identification of the cyclic GMP/NO pathway as the final neurotransmitter messengers responsible for penile erection and the subsequent development of highly specific phosphodiesterase enzyme inhibitors has revolutionised the treatment of erectile dysfunction. Sildenafil citrate and tadalafil citrate are effective, well tolerated and safe treatments for erectile dysfunction caused by a broad range of aetiologies.1,2 Priapism for longer than 6 h is a recognised complication of intracavernous injection therapy and have been reported to occur in 0.25% of men using alprostadil monotherapy and 0.9% of men using combination pharmacotherapy containing alprostadil, papaverine and phentolamine.3,4 An extensive review of the published medical literature and the manufacturer's clinical trial and postmarketing database identified six reports of priapism following the use of sildenafil in an estimated 1.2 billion users.5,6,7,8 Several authors have reported that 15–25% of men previously treated with intracavernous injection therapy who respond to sildenafil will choose to alternate between both forms of therapy according to circumstance.9,10 Combination therapy using sildenafil and intracavernous combination pharmacotherapy have been reported to salvage 30% of men refractory to either treatment alone.11 We report three cases of priapism occurring in men following intracavernous self-administration of vasoactive drugs following administration of a phosphodiesterase inhibitor drug.

A 46-year-old man with type II diabetes, hypertension and dyslipidaemia and a 4-year history of erectile dysfunction, presented with a painful priapism 7 h following the administration of oral sildenafil (100 mg) and the subsequent intracavernous administration of alprostadil (15 μg). Corporal aspiration of dark deoxygenated blood confirmed the presence of a low flow ischaemic priapism. The patient had recently been prescribed sildenafil by his local medical officer and had failed to achieve an erection sufficient for penetration on each of the three occasions when he attempted intercourse approximately 10 min after ingestion of the drug. On the third administration, he administered an intracavernous injection of alprostadil approximately 1 h after ingestion of sildenafil. His priapism subsided after serial corporal aspiration and irrigation with dilute phenylephrine. Subsequent penile duplex Doppler ultrasonography did not demonstrate any postpriapism corporal fibrosis. Following dose titration and re-education, he now responds well to sildenafil and no longer uses intracavernous injection therapy.

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  1. Australian Centre for Sexual Health, Sydney, Australia

    C G McMahon

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  1. C G McMahon
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Correspondence to C G McMahon.

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McMahon, C. Priapism associated with concurrent use of phosphodiesterase inhibitor drugs and intracavernous injection therapy. Int J Impot Res 15, 383–384 (2003). https://doi.org/10.1038/sj.ijir.3901046

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