High-Flow Priapism and Glans Hypervascularization following Deep Dorsal Vein Arterialization for Vasculogenic Impotence

Abstract

Microsurgical penile revascularization is becoming an increasingly applied technique in patients with arteriogenic or mixed arteriogenic and venogenic impotence. Deep dorsal vein arterialization has been used successfully in selected patients. Aside from failure of the procedure and the occasional problems associated with vascular surgery, priapism and glans hypervascularization are specific complications of deep dorsal vein arterialization. Priapism in these cases is ‘high-flow’; the functional arterial-cavernous fistula can overcome the maintenance of the flaccid state and cause persistent erection. Glans hypervascularization, a syndrome of glans enlargement, skin changes and pain secondary to excessive retrograde filling of the glans penis and corpus spongiosum, can result in urethral compression and glans ulceration. Along with the presentation of the case of a man who suffered both complications, we discuss their pathophysiology, prevention, and treatment.

Evaluation and management of priapism: 2009 update

“…Non-ischemic priapism has been reported as a complication of medical and surgical management of ischemic priapism. 56–58 Other surgical procedures associated with non-ischemic priapism include cold-knife internal urethrotomy for urethral stenosis, 59 hydraulic erection during Nesbit corporoplasty, 60 deep dorsal vein arterialization for vasculogenic impotence, 61 and self-administered ICP for ED. 62 …”