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Case Reports
. 2021 Apr 1;14(4):e241897.
doi: 10.1136/bcr-2021-241897.

Treatment-resistant priapism associated with long-term low-molecular-weight heparin

David Bouchier-Hayes  1 , Philip Nolan  2   3 , Gordon Pate  4
Affiliations
Case Reports

Treatment-resistant priapism associated with long-term low-molecular-weight heparin

David Bouchier-Hayes et al. BMJ Case Rep. .

Abstract

This case report summarises the case of a 56-year-old man with low-flow, ischaemic priapism requiring urgent insertion of a penile prosthesis following prophylactic anticoagulation with tinzaparin. Low-molecular-weight heparin (LMWH) has been proposed as a cause of ischaemic priapism, although reported cases of this are rare. This particular side effect of tinzaparin has been reported once in a case report in 2018, and there are scant other reports of LMWH-induced priapism. This case was refractory to the full treatment algorithm, including multiple aspirations, phenylephrine injection, cavernosal shunt and required transfer for implantation of a penile prosthesis. Only one other case of such a severe case of priapism has been documented, involving LMWH and warfarin. Documented evidence of possible causes of priapism are vital, given the rarity of this condition, the frequency of LMWH and the potentially devastating complications.

Keywords: haematology (drugs and medicines); urology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Drainage of blood from corpora cavernosa, O2 of 3.99 kPa, CO2 of 12.4 kPa, pH of 6.98.
Figure 2
Figure 2
Passing biopsy gun through glans to create a shunt between corpus spongiosum and both corpora cavernosa.
See this image and copyright information in PMC

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