To evaluate the clinical characteristics, risk factors, and outcomes of priapism following intracavernosal injection (ICI) therapy, with specific focus on comparing in-office, prescribed, and recreational ICI patterns.
A retrospective review identified patients presenting with priapism (ICD-10: N48.3) at a single institution from November 2015 through September 2024. Cases were classified as acute ischemic, recurrent ischemic, or nonischemic, and stratified by ICI administration setting: in-office, prescribed, or recreational. Demographics, clinical presentation, management strategies, and erectile function outcomes were analyzed using descriptive statistics.
Of 186 priapism cases, 102 (54.8%) were ICI-related. Among these, 75.4% presented as acute ischemic and 24.5% as recurrent ischemic (mean 2.5 ± 0.7 recurrences). In-office and prescribed injections each accounted for 39.2% of cases, while recreational use comprised 21.6%. Median priapism duration varied significantly by setting: 3 hours (IQR: 2-4) for in-office, 7 hours (IQR: 6-12) for prescribed, and 30 hours (IQR: 12-63) for recreational use (p<0.001). Recreational users demonstrated significantly higher rates of HIV and illicit drug use (p<0.001). Post-priapism outcomes revealed that 57% of patients discontinued prescribed ICI therapy, while 65% of previously unaffected recreational users developed de novo erectile dysfunction.
ICI-induced priapism represents a significant clinical challenge, with duration of priapism varying markedly between in-office, prescribed, and recreational use. The high rate of ICI discontinuation following priapism suggests a substantial impact on ED management decisions. The association between recreational use and adverse outcomes, including de novo ED, identifies an important area for clinical outreach and risk mitigation strategies.
Urology. 2025 Apr 24 [Epub ahead of print]
Joseph A Borrell, Anthony Bettencourt, Thiago P Furtado, Anael Rizzo, Juan J Andino, Sriram V Eleswarapu, Jesse N Mills
UCLA David Geffen School of Medicine, Los Angeles, California. Electronic address: ., UCLA David Geffen School of Medicine, Los Angeles, California., Department of Urology, University of California, Los Angeles, California.