Tamsulosin-induced priapism: A case report

JEM reports Pub Date : 2024-11-07 DOI:10.1016/j.jemrpt.2024.100125

Julie Martino , Zane Elfessi , Heather Webster

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Abstract

Background

Priapism is a persistent erection generally lasting more than 4 h. Types of priapism include recurrent, ischemic, and non-ischemic and are generally classified based on penile arterial blood flow. Priapism can be induced by hematologic disorders (i.e. sickle cell anemia), infections, recreational drug use, and medication use. Tamsulosin is an α_1A receptor antagonist commonly used in the treatment of LUTS and benign prostatic hyperplasia (BPH).

Case report

We report a case of priapism lasting 48 hours due to tamsulosin. Aspiration and irrigation of the corpus cavernosa and intracavernosal injection of phenylephrine were performed without success. A penile blood gas revealed a pH of 6.92, pCO2 of 108 mmHg, pO2 of 40 mmHg, and HCO3 of 22.2 mmol/L—indicating ischemic priapism. A T-shunt was performed through the glans with moderate detumescence—the penis was able to bend at least 60° in all directions and 90° ventrally. The patient had a computed tomographic angiography (CTA) of the pelvis and a magnetic resonance angiography (MRA) 1 and 3 months later, respectively, which indicated proper flow and the absence of arteriovenous malformations.

Why should an EM Physician be aware of this?

Despite its attractive nature for the treatment of LUTS or BPH, because of α_1A receptor selectivity, tamsulosin should be recognized as a culprit of priapism. Because of the high affinity for the α_1A receptor, patients on tamsulosin may not respond to traditional medical therapies for priapism and therefore may require surgical intervention.

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坦索罗辛诱发的前列腺增生症：病例报告

Priapism 的类型包括复发性、缺血性和非缺血性，一般根据阴茎动脉血流进行分类。血液系统疾病（如镰状细胞性贫血）、感染、使用娱乐性药物和使用药物都可能诱发勃起功能障碍。坦索罗辛是一种α1A受体拮抗剂，常用于治疗尿失禁和良性前列腺增生症（BPH）。对阴茎海绵体进行了抽吸和冲洗，并在阴茎海绵体内注射了苯肾上腺素，但均未奏效。阴茎血气显示pH值为6.92，pCO2为108 mmHg，pO2为40 mmHg，HCO3为22.2 mmol/L--表明患者患有缺血性前列腺肥大症。通过龟头进行了 T 型分流术，中度消肿--阴茎在各个方向至少可以弯曲 60°，在腹侧可以弯曲 90°。患者分别在 1 个月和 3 个月后接受了骨盆计算机断层扫描（CTA）和磁共振血管造影（MRA）检查，结果显示血流正常且无动静脉畸形。为什么急诊科医生应该注意这一点？尽管坦索罗辛在治疗 LUTS 或良性前列腺增生症方面很有吸引力，但由于其具有 α1A 受体选择性，因此应该认识到坦索罗辛是导致早泄的罪魁祸首。由于坦索罗辛对α1A受体具有高亲和力，服用坦索罗辛的患者可能对治疗尿失禁的传统药物疗法无效，因此可能需要手术干预。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JEM reports Emergency Medicine

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审稿时长

54 days