黃冠鈞、邱文祥^1,2、林文榮、陳建志^1,3、楊志東、周永強¹、蔡維恭、江百凱、張奐光、林文州、許炯明¹、林鼎博、李致樵

Kuan-Chun Huang , Allen Wen-Hsiang Chiu^1,2, Wun-Rong Lin , Marcelo Chen^1,3, Stone Yang, Yung-Chiong Chow¹, Wei-Kung Tsai, Pai-Kai Chiang, Huang-Kuang Chang, Wen-Chou Lin, Jong-Ming Hsu¹, Ting-Po Lin, Chih-Chiao Lee

Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan; Mackay Medical College¹, New Taipei City , Taiwan ; School of medicine, National Yang-Ming University² , Taiwan ; Mackay junior College of Medicine, Nursing, and Management³, New Taipei City

 

Introduction: Priapism is a rare disease defined as pathological penile erection without sexual desire or stimulation. It may lead to urologic emergency if this situation persist more than 4 hours. Irreversible damage could happen in the cavernous tissue resulting in impotence if there is no timely and proper treatment. There are several etiology may cause the priapism. Now we report a rare case of priapism caused by low molecular weight heparin(LMWH) therapy and warfarin.

Case report: A 67-year-old male suffered from left thigh swelling with pain for 3 days. Blood examination for D-dimer showed more than 5000 ng/mL. Left thigh deep vein thrombosis(DVT) was diagnosed. Enoxaparin , one of LMWH 60mg twice daily plus Warfarin 5mg daily were prescribed for DVT treatment during hospitalization. On the third day of treatment, urologist was consulted due to painful prolong erection of penis for 2 days. Corpus cavernosum irrigation were performed under general anesthesia. We used two 18G niddle for irrigation and aspiration separately with one inserted on the proximal side of corpus cavernosum connected with normal saline for irrigation and the other inserted on the top of glans for aspiration.(picture A) However, small amount of blood was aspired so the tunica vaginalis was cut for exposed the corpus cavernosum. Dark red cavernosal tissue with minimal blood ooze was noted.(picture A) After discuss with the patient, due to the old age, penile prosthesis implantation was suspended. After following up for 12 days during hospitalization, neither distumescence of penis nor gangrene change were noted.( picture B)

Discussion: low molecular weight heparin therapy or warfarin induce priapism are rare condition only reported previous with few cases.[1] low molecular weight heparin are convinced may induce antiplatelet antibodies activity lead to thrombocytosis which decreases penile blood flow . The other theory for LMWH causing ischemic priapism is high flow priapism in the beginning and turn into low flow priapism in the end.