Refractory Ischemic Priapism Following Hemodialysis

TL;DR

A 57-year-old man with kidney disease developed a rare, painful erection emergency after dialysis, requiring surgery and highlighting the need for more research.

Contribution

The paper presents a novel case linking hemodialysis, erythropoietin, and heparin to refractory ischemic priapism.

Findings

The patient's ischemic priapism was refractory to standard treatment, requiring surgical shunting.

Blood gas analysis showed severe acidosis and hypoxemia, indicating systemic effects.

Erythropoietin and heparin are suggested as potential contributors to priapism in dialysis patients.

Abstract

Priapism, characterized by prolonged and painful penile erection, is a rare urological emergency with diverse etiologies. We present a case of refractory ischemic priapism following hemodialysis in a 57-year-old male with a history of type II diabetes mellitus, hypertension, and end-stage renal disease. Despite standard conservative management, the patient's condition persisted, necessitating penile distal shunting through an intracorporeal dilatation plus Al-Ghorab corporoglandular shunt. Blood gas analysis of corpus cavernosum blood revealed severe acidosis and hypoxemia, emphasizing the systemic impact of ischemic priapism. The patient's history of erythropoietin injections and the administration of heparin during dialysis emerged as potential contributors to priapism. We discuss the complex interplay between erythropoietin, coagulation cascade, and heparin in the context of priapism development. The case underscores the need for further research to understand the specific mechanisms contributing to priapism in patients undergoing hemodialysis.