Background:
Tamsulosin in a widely used
drug in urology practice in treating
lower urinary tract symptoms of
benign prostatic hyperplasia, distal ureteral stones, and ureteral
stent-related symptoms. Ischemic
priapism is a rare but serious adverse effect of
tamsulosin. We report two cases of
tamsulosin-induced
priapism and reviewed available literature citing
priapism as a complication of
tamsulosin. We also reviewed the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database to identify reported cases of
tamsulosin-induced
priapism. Case Presentation: First patient was a 61-year-old African American male with
paraplegia of 30-year duration. He developed
priapism after taking first dose of
tamsulosin for
lower urinary tract symptoms. He presented with 18 hours of painful erection and was treated with aspiration and irrigation, followed by
phenylephrine injection. The patient maintained potency
after treatment. The second patient was a 24-year-old male who received
tamsulosin in the emergency department as medical expulsive
therapy for 11 mm distal ureteral stone. Since he had
intractable pain, he underwent emergency primary ureteroscopy with
laser lithotripsy as definitive treatment of his
ureteral calculus. He developed intraoperative
priapism that subsided postoperatively. However, he was discharged with
tamsulosin to reduce
stent-related urinary symptoms. He returned back to the emergency department after 3 days with persistent
priapism for 3 days and needed penoscrotal corporeal
decompression to treat his
priapism. At 6 weeks follow-up visit, the patient has lost his potency. Although there were only 4 case reports on review of the literature, we were able to identify 46 cases reported in the U.S. FAERS database. Conclusion:
Priapism can be an adverse reaction to
tamsulosin. Providers and patients should be aware about this complication to ensure early seeking of management to avoid devastating outcomes, particularly in young patients when
tamsulosin is given as medical expulsive
therapy for ureteral stone and
stent-related symptoms.