Priapism secondary to tamsulosin: A case report

Priapism is a rare urological emergency, characterized by prolonged erection unrelated to sexual stimulation, with a high risk of irreversible complications. We report the case of a 67-year-old patient, with no notable history, treated with tamsulosin 0.4 mg/day for benign prostatic hyperplasia. Three days after initiation of treatment, he presented with ischemic priapism persisting for more than 72 hours. Clinical examination and further investigations, including cavernous blood gases (pO₂ 9.7 mmHg, pCO₂ 89 mmHg) and Doppler ultrasound, confirmed low-flow priapism. Conservative treatments (intra-cavernosal ephedrine injections, aspiration) failed, necessitating multi-stage surgical management: Winter shunt, cavernospongiosus T-shunt, then proximal Quackels-type shunt, having allowed complete detumescence. The potential pathophysiological mechanism lies in the inhibition of sympathetic tone by tamsulosin, leading to excessive relaxation of cavernous smooth muscle. This case highlights the need for clinicians to recognize this rare but severe complication and to act swiftly to preserve erectile function. When prescribing alpha-blockers, it is essential to inform patients of this risk beforehand.