# Presentations Due to Priapism in an Urban Hospital in Switzerland

## TL;DR

This study examines priapism cases at a Swiss hospital, finding most are ischaemic and linked to medications, highlighting the need for awareness and further research.

## Contribution

The study provides a detailed analysis of priapism cases in an urban Swiss hospital, focusing on causes and management strategies.

## Key findings

- Most priapism cases were ischaemic, with low-flow type confirmed in 91% of tested cases.
- Drug-induced priapism was linked to medications like trazodone, sildenafil, and corpus cavernosum autoinjection therapy.
- Recurrence was common, with 13 cases experiencing at least one recurrence, including 10 within a week.

## Abstract

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.