A rare case of normal erections in a patient with recurrent priapism treated with multiple shunt surgeries and anti-platelets

This case report discusses a 23-year-old male with recurrent priapism and its management. Priapism, defined as prolonged and painful penile erection, can lead to severe complications including permanent erectile dysfunction (ED) and penile deformities. The patient presented with priapism lasting 34 hours, despite previous spontaneous resolution of similar episodes. Initial treatment involved blood aspiration and irrigation with epinephrine, but the priapism recurred. Various shunting procedures were attempted, yet recurrent priapism persisted. Discussion highlights the challenge of maintaining shunt patency due to thrombosis and the importance of blood flow through the shunt for healing. The report introduces the notion of pre-operative aspirin and post-operative heparin to prevent shunt closure, though guidelines do not currently support this approach. Prior research suggests aspirin's positive impact on erectile function through enhanced nitric oxide production and platelet inhibition. The report concludes by recommending a treatment protocol involving initial aspiration and irrigation, followed by pre-operative aspirin, shunt surgery, and post-operative aspirin for 6 months to prevent shunt closure. This case emphasizes the need for further studies to validate the efficacy of anti-platelet therapy as part of priapism management.