Exploring the Clinical Landscape of Priapism Related to Intracavernosal Injection Therapy: Patient Characteristics, Management Patterns, and Erectile Dysfunction Outcomes

Joseph A Borrell; Anthony Bettencourt; Thiago P Furtado; Anael Rizzo; Juan J Andino; Sriram V Eleswarapu; Jesse N Mills

doi:10.1016/j.urology.2025.04.042

Exploring the Clinical Landscape of Priapism Related to Intracavernosal Injection Therapy: Patient Characteristics, Management Patterns, and Erectile Dysfunction Outcomes

Urology. 2025 Apr 25:S0090-4295(25)00398-X. doi: 10.1016/j.urology.2025.04.042. Online ahead of print.

Authors

Joseph A Borrell¹, Anthony Bettencourt², Thiago P Furtado³, Anael Rizzo², Juan J Andino³, Sriram V Eleswarapu³, Jesse N Mills³

Affiliations

¹ UCLA David Geffen School of Medicine, Los Angeles, CA. Electronic address: jborrell@mednet.ucla.edu.
² UCLA David Geffen School of Medicine, Los Angeles, CA.
³ Department of Urology, University of California, Los Angeles, CA.

PMID: 40287023
DOI: 10.1016/j.urology.2025.04.042

Abstract

Objective: To evaluate the clinical characteristics, risk factors, and outcomes of priapism following intracavernosal injection (ICI) therapy, with specific focus on comparing in-office, prescribed, and recreational ICI patterns.

Methods: A retrospective review identified patients presenting with priapism (ICD-10: N48.3) at a single institution from November 2015 through September 2024. Cases were classified as acute ischemic, recurrent ischemic, or non-ischemic, and stratified by ICI administration setting: in-office, prescribed, or recreational. Demographics, clinical presentation, management strategies, and erectile function outcomes were analyzed using descriptive statistics.

Results: Of 186 priapism cases, 102 (54.8%) were ICI-related. Among these, 75.4% presented as acute ischemic and 24.5% as recurrent ischemic (mean 2.5 ± 0.7 recurrences). In-office and prescribed injections each accounted for 39.2% of cases, while recreational use comprised 21.6%. Median priapism duration varied significantly by setting: 3 hours (IQR: 2-4) for in-office, 7 hours (IQR: 6-12) for prescribed, and 30 hours (IQR: 12-63) for recreational use (P <.001). Recreational users demonstrated significantly higher rates of human immunodeficiency virus (HIV) and illicit drug use (P <.001). Post-priapism outcomes revealed that 57% of patients discontinued prescribed ICI therapy, while 65% of previously unaffected recreational users developed de novo erectile dysfunction.

Conclusion: ICI-induced priapism represents a significant clinical challenge, with the duration of priapism varying markedly between in-office, prescribed, and recreational use. The high rate of ICI discontinuation following priapism suggests a substantial impact on ED management decisions. The association between recreational use and adverse outcomes, including de novo ED, identifies an important area for clinical outreach and risk mitigation strategies.