Cocaine associated priapism

Purpose: Cocaine abuse is an ongoing epidemic in the United States. Priapis m associated with cocaine use has been reported only twice in the urologica l literature. To our knowledge we report the first series of priapism assoc iated with cocaine use and the first case associated with the use of this d rug in its solid form, known as crack. Materials and Methods: We retrospectively reviewed the presentation of 3 pa tients to our emergency department within the last year. Each patient prese nted with priapism and no identifiable predisposition other than the use of cocaine within 24 hours, as evident on positive urine toxicology. Results: Each patient delayed seeking treatment, which added to the complex ity of therapy. Intracavernosal aspiration and irrigations failed in all 3 cases. Cavernous spongiosal shunting failed in the first 2 cases. Cases 2 a nd 3 were complicated by the high flow variant of priapism. Case 1 ultimate ly required partial penectomy for infected, gangrenous, distal penile tissu e. Conclusions: It appears that cocaine can be a cause of refractory priapism and treatment can be challenging. We suggest that urine toxicology screenin g be considered in such cases. The identification of underlying cocaine abu se is important in preventing priapism recurrence in these patients.