Highly selective embolization of bilateral cavernous arteries for post-traumatic penile arterial priapism

Abstract

High-flow priapism is characteristically diagnosed on clinical findings: a prolonged, non-painful erection with a delayed onset that develops after a penile or perineal trauma. If conservative measures fail arteriography is indicated, which shows a blush of extravasating contrast from an arterio-cavernous fistula (rarely, as in our case bilateral) that can be treated by embolization. The embolic agent is gelfoam or a microcoil. Bilateral embolization is indicated when unilateral treatment does not result in detumescence of the penis. When the embolization is done highly selective the risk of complications is low and the results on erectile function are good.

Priapismo arterial de alto flujo secundario a fístula arterio-cavernosa bilateral post-traumática: Embolización supraselectiva con coágulo autólogo

“…La embolización con sustancias no reabsorbibles (bucrylato, microcoil,...), pueden causar disfunción eréctil o disminución de la rigidez eréctil por falta de recanalización arterial posterior 1 . Las sustancias no reabsorbibles radiopacas (como los microcoils) tienen a su favor la propiedad de permitir una mayor exactitud en su posicionamiento y mejor control radiológico y seguimiento posterior debido a su radiopacidad 6 .…”

“…Existen once casos publicados de priapismos de alto flujo arterial secundarios a fístulas arterio-lacunares bilaterales 1 . Nosotros presentamos un nuevo caso de fístula bilateral con completa iconografía y resuelto con éxito por la escasa frecuencia de estas fístulas bilaterales y la controversia existente respecto al tratamiento de las mismas.…”

Embolization Treatment of High-Flow Priapism

“…24 Recurrent or residual erectile dysfunction after embolization treatment has been reported in approximately 15 to 22% of high-flow priapism patients. 20,21,25,26 Several occlusive agents can be used for selective arterial embolization, including autologous blood clot, gelatin sponge, microcoils, polyvinyl alcohol, and glue. All of these occlusive agents achieve a similar 75% resolution rate.…”

The modern approach to high-flow priapism

“…Erectile dysfunction following high-flow priapism treatment has been reported in 15% to 20% of paitients [18,22]. Patients (7%) who had reported decrease in their quality of erections needed pharmacotherapy for satisfactory sexual intercourse [14•].…”