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There are several etiology related to priapism with incidence is less than 0.01%. A 47-year-old man was referred to our Emergency Room with a chief complaint of persistent and painful erection for 3 days. Previously, the patient took Tadalafil 5 mg to overcome the complaints of erectile dysfunction that he felt after undergoing (TURBT) and external radiation treatment. The patient treated with epinephrine injection and distal shunting surgical procedure Minimal and single dose of tadalafil can cause priapism as in this case. Time interval between onset and therapy affect patient outcome.