Elsevier

Urology

Volume 66, Issue 2, August 2005, Pages 432.e15-432.e18
Urology

Case report
Tadalafil-associated priapism

https://doi.org/10.1016/j.urology.2005.02.019Get rights and content

Abstract

A healthy 46-year-old man presented to the Emergency Department with a 36-hour history of persistent, painful erection after taking the cyclic guanylyl monophosphate-specific phosphodiesterase 5 inhibitor tadalafil. He had no other identified contributing factors for priapism. After confirmation of ischemic priapism and failure of bedside management in the Emergency Department, the patient underwent operative caverno-spongiosal shunting. Postoperatively, the erection initially rebounded but gradually receded with manual compression over 48 hours. At outpatient follow-up, the patient remained flaccid without erections. To our knowledge, this is the first report of tadalafil-associated priapism.

Section snippets

Case report

A 46-year-old white man presented to the Emergency Department in mild distress, complaining of a rigid, painful erection for approximately 36 hours. He denied any desire or interest in sexual stimulation. Two evenings earlier, an acquaintance had provided him with an unknown dose of tadalafil, to which he was naïve. After completing intercourse with his wife, he fell asleep, only to awaken the next morning with a painful erection. Hoping for spontaneous resolution, he waited an additional 24

Comment

Phosphodiesterase-5 inhibitors have revolutionized the medical management of erectile dysfunction. Despite the warnings of inappropriately prolonged erection listed on popular advertisements, the risk of priapism associated with these medications is largely unknown. Tadalafil-related priapism is thought to be exceedingly rare. A postmarketing safety surveillance study by Eli Lilly reported the risk of tadalafil-associated priapism as less than 1 in 10,000.1 Only a handful of case reports of

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  • Priapism: Pathogenesis, epidemiology, and management

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    Tadalafil 5 mg daily dosing caused no priapism in a Phase II clinical study of 281 men with history of lower urinary tract symptoms secondary to benign prostatic hyperplasia for 6 weeks followed by dosage escalation to 20 mg once daily for 6 weeks [28]. From 1999 to 2007, there have been at least nine case-based reports of oral PDE5 inhibitor dosing and adult priapism and at least one pediatric case: Aoyagi [29]; Sur [30]; Kassim [31]; Goldmeier[32]; McMahon [33]; Wilt [34]; Galatti[35]; Kumar [36]; King [37]; Wills [38]. The majority of these cases detail histories of men with increased risk for priapism: SCD, spinal cord injury, men who used PDE5 inhibitor recreationally, men who used PDE5 inhibitor with ICI, men with history of penile trauma, men on psychotropic medications, or men abusing narcotics.

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1

H. Wessells is a lecturer for Pfizer.

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