Self-Concocted Mixture of Liquid Oral Tadalafil Resulting in Ischemic Priapism: A Cautionary Tale
Abstract
Priapism, particularly ischemic priapism, is a medical emergency that requires prompt intervention to prevent permanent erectile dysfunction. Both prescription and recreational drugs have been implicated in its cause. This case highlights the consequences of intracavernous injection of a self-made mixture of crushed oral tadalafil after failure of oral tadalafil to induce an erection.
A 57-year-old male with a history of major depressive disorder, attention deficit hyperactivity disorder, and erectile dysfunction presented to the emergency department with a painful erection lasting approximately 36 hours. After oral tadalafil failed to achieve an erection, he crushed another tablet, mixed it with water, and injected it intracavernously. This caused a sustained, painful erection. The patient attempted various techniques, including masturbation and ice packs, but the erection persisted. On arrival at the emergency department, a corporal blood gas analysis confirmed ischemia. Initial bedside aspiration and phenylephrine injection offered minimal relief, and he opted for distal shunting after further discussion. The procedure successfully achieved detumescence.
This case underscores the risks accompanying improper use of erectile dysfunction treatments, specifically, when oral tadalafil is administered intracavernously. Priapism resulting from such usage caused prolonged ischemia, requiring invasive procedures for resolution. This highlights the rare adverse reaction of…
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