Is the combination of superselective transcatheter autologous clot embolization and duplex sonography-guided compression therapy useful treatment option for the patients with high-flow priapism?

Abstract

The aim of this study was to report feasibility, benefit and complications of superselective transcatheter autologous clot embolizations and duplex sonography-guided compression therapy in four patients with delayed post-traumatic high-flow priapism. Medical records of four consecutive patients diagnosed with delayed post-traumatic high-flow priapism (arterial priapism) were reviewed. High-flow priapism occurred mean 41.8 (6-92) h after the trauma developed. The patients were presented to hospital mean 8.3 (5-15) days after priapism occurred. The patients were assessed by penile color flow Doppler sonography. After the pathologically increased, arterial flow or arteriocavernosal fistula was seen, combination therapy with superselective transcatheter autologous clot embolizations and duplex sonography-guided compression was performed. If complete detumescence could not be achieved, this therapy was applied in the following day. In patients who had resistance to the second embolization, superselective embolization with microcoil was performed. Follow-up included penile color flow Doppler sonography at the following day, 1 month and 3 months after the procedure. International Impotence Symptoms Score (IIEF) was obtained during the follow-up. The treatment was successful in one, partially successful in one and not successful in two of the four patients. This therapy was reperformed to the latter three patients. After the treatment, high-flow priapism disappeared in one of the three patients and embolization with methalic microcoil was needed to perform to the other two patients. At 1 day after the treatment, color flow Doppler sonography and physical examinations were normal in all four patients. In the 1st and 3rd months of the follow-up, color flow Doppler sonography and the NPT tests were normal in three of the four patients. Slight erectile dysfunction was detected in one patient. Combination of superselective transcatheter autologous clot embolizations and duplex sonography-guided compression therapy may be considered as one of the first-line treatment options in adult patients with delayed post-traumatic high-flow priapism.

Acute management of priapism in men

“…However, these procedures may be complicated by penile gangrene, gluteal ischaemia and purulent cavernositis. Furthermore, the recurrence rate after a single embolisation is 30 -40% with a concomitant risk of erectile dysfunction of 5% and 39%, for absorbable and nonabsorbable materials, respectively [ 1,5,51 ] .…”

“…In this situation vessel recanalization will lead to preservation of erectile function [ 49,52 ] . Combined super-selective embolisation and Doppler US-guided compression have recently been reported to achieve higher rates of success [ 51 ] .…”

“…This treatment aims to disrupt the aberrant arteriovenous connection. Alternatively, occlusion of the cavernous artery is under taken [ 5,51 ] . However, these procedures may be complicated by penile gangrene, gluteal ischaemia and purulent cavernositis.…”

Priapism: Current Updates in Clinical Management

“…The aim of this treatment is to disrupt the aberrant arteriovenous connection. Alternatively, occlusion of the cavernous artery is performed [40]. However, these procedures can be complicated by gluteal ischemia, penile gangrene, or purulent cavernositis.…”

“…However, these procedures can be complicated by gluteal ischemia, penile gangrene, or purulent cavernositis. In addition, the recurrence rate after a single embolization is 30% to 40% with a concomitant hazard of erectile dysfunction of 5% and 39%, for absorbable and nonabsorbable materials, respectively [1,40]. Erectile dysfunction can be transient if nonabsorbable materials, e.g., gelatin foam or autologous clots, are used.…”