Pharmacological Priapism Requiring Penile Implant in a 50-Year-Old Man with Erectile Dysfunction

Background: Most men around the world experience erectile dysfunction at some point in their lives. Not only is this condition a physiologic deficit, but it can also lead to depression, anxiety, lack of self-esteem, and lack of confidence which can make the underlying disorder worse. Erectile dysfunction can develop due to various organic, relational, and psychological causes. Case Information: A 50 year-old Caucasian male presents to the emergency department with priapism for a period of over six hours secondary to the use of Trimix, an intracavernosal and intraurethral injectable three-drug medication. After four repeated episodes of the priapism resolving and reappearing after aspiration and phenylephrine injections over the course of 24 hours, the priapism finally resolved. During an outpatient office visit to the urologist a week later, discussion about the patient's past medical history of failure of first-line and second-line medical therapies, including use of Viagra, Cialis, and Trimix, as well as episodes of priapism, resulted in the decision for the patient to undergo an elective inflatable penile implant procedure. Conclusions: While conservative treatment of erectile dysfunction is considered first-line management, medications and lifestyle modifications are not always effective for patients. Patients often resort to using injections, creams, and alternative therapies. Despite the efficacy of injections, high discontinuation rates have been reported and a risk of priapism has long been a concern. When these therapies are ineffective, it may be necessary for patients to undergo penile implantation surgery.