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Case report
Treatment-resistant priapism associated with long-term low-molecular-weight heparin
  1. David Bouchier-Hayes1,
  2. Philip Nolan2,3 and
  3. Gordon Pate4
  1. 1 Urology, Galway Clinic, Doughiska, Ireland
  2. 2 Urology, Galway Clinic, Galway, Ireland
  3. 3 Urology, Galway University Hospitals, Galway, Ireland
  4. 4 Cardiology, Galway Clinic, Galway, Ireland
  1. Correspondence to Professor David Bouchier-Hayes; davidbouchierhayes{at}yahoo.co.uk

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.

  • haematology (drugs and medicines)
  • urology

https://doi.org/10.1136/bcr-2021-241897

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    Footnotes

    • Contributors DB-H (myself) was the lead consultant on the case. GP was the referring physician and the person who had started the patient on low-molecular-weight heparin (LMWH) and diagnosed the presenting priapism and advised on the issues related to the cardiology and LMWH involvement in the case. I managed the patient from his initial presentation through his surgery which I performed through to his transfer. I also took the initial clinical photos. PN reviewed the case notes, and using these drafted the original manuscript, as well as researched the condition and put the images in order, as well as referencing the manuscript. I reviewed the draft manuscript and suggested alterations in conjunction with PN, which he then completed. I then submitted the completed manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.