Priapism is a persistent penile erection that is unrelated to sexual stimulation. Subtypes of priapism include ischaemic, nonischaemic and stuttering. Stuttering or intermittent priapism is a recurrent form of ischaemic priapism in which penile erections occur repeatedly with intervening periods of detumescence. Although each episode of stuttering priapism may last only for a short duration with spontaneous penile detumescence, the condition challenges the physician to develop a management strategy for the prevention of future episodes of priapism. Treatment modalities for patients with stuttering priapism include systemic therapies, early self-injection of sympathomimetic agents (eg phenylephrine) into the corpus cavernosum and, as a last resort, surgical placement of a penile prosthesis. Among the systemic therapies, hormonal agents, baclofen, digoxin and terbutaline have been used to prevent stuttering priapism although the American Urological Association Guidelines for management of priapism do not recommend the use of terbutaline or digoxin for prevention of stuttering priapism. At present, there is little evidence to support the use of either terbutaline or digoxin in this clinical setting.1 Hormonal therapy for stuttering priapism suppresses serum testosterone levels by feedback inhibition (diethylstilbestrol), blocking androgen receptors (antiandrogens), or by downregulation of the pituitary gland (gonadorelin analogues). We describe management of a patient with cervical spinal cord injury, who developed recurrent episodes of penile erection.

A 46-year-old male sustained C-4 complete tetraplegia in a mountain bike accident. CT scan showed burst fracture of C-4 vertebra, and fracture of arch of C-1. There was no evidence of trauma to pelvis or perineum. He underwent C-4 vertebrectomy, grafting and plating. He was sedated and ventilated through a cuff tracheostomy tube, when he was transferred to the spinal unit about a month after the accident. During his stay in the spinal injuries unit, he was weaned off the ventilator. Later, the tracheostomy tube was removed. He had a size 12 Fr. Foley catheter per urethra for drainage of urinary bladder. Medications included salbutamol nebuliser four times a day, omeprazole, carbamazepine, mianserin, senna syrup, bisacodyl rectal solution, and dalteparin sodium for prevention of deep-vein thrombosis.

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