Post‐traumatic high flow priapism: Demonstrable findings of penile enhanced computed tomography

Suzuki, Kaoru; Nishizawa, Shuji; Muraishi, Osamu; Fujita, Akifumi; Hyodoh, Hideki; Tokue, Akihiko

doi:10.1046/j.1442-2042.2001.00391.x

Cited by 14 publications

(5 citation statements)

References 35 publications

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“…In addition, the sensitivity of CDUS in localizing an arteriocavernosal fistula is almost 100%[ 20 ]. CTA has a similar value to CDUS in the diagnosis and follow-up of HFP[ 21 ]. Relative to CDUS, CTA has advantages in the detection of pelvic injuries, pelvic vascular anatomy, and anatomic variants.…”

Section: Discussionmentioning

confidence: 99%

High-flow priapism due to bilateral cavernous artery fistulas treated by unilateral embolization: A case report

Guo¹,

Liu²,

Wang³

et al. 2023

World J Clin Cases

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BACKGROUND High flow priapism (HFP) is a rare type of priapism. Perineal trauma is the most common cause of HFP. Trauma-induced penile artery injury may lead to an arterial-cavernosal fistula, whereas persistent irregular arterial blood flow entering the corpora cavernosum can cause a persistent penile erection. The routine treatment of HFP focuses on addressing the abnormal penile erectile status and avoiding post-treatment erectile dysfunction. Interventional embolization is an important therapeutic modality for HFP, and bilateral embolization therapy is currently the most commonly used technique for patients with bilateral cavernous artery fistulas; however, unilateral embolization therapy has yet to be reported. CASE SUMMARY Herein, we report of the case of a 26-year-old Chinese male who presented with a persistent abnormal erection for 12 h after perineal impact injury. Medical history, cavernous arterial blood gas analysis and radiological examinations led to a diagnosis of HFP caused by bilateral cavernous artery fistulas. We performed routine conservative treatment (compression therapy and ice application) for the patient after admission; however, 10 d later, his symptoms had not been relieved. After completion of the preoperative workup, right (severe side) selective perineal artery embolization was performed; the left cavernous artery fistula was left untreated. After postoperative continuation of conservative treatment for 72 h, the patient experienced complete penile thinning. The patient had no symptoms of erectile dysfunction over a follow-up period of 12 mo. CONCLUSION Compared with bilateral cavernous artery fistula embolization, we believe that unilateral cavernous artery fistula embolization can achieve positive clinical efficacy and reduce the risk of postoperative erectile dysfunction secondary to penile ischemia.

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Section: Discussionmentioning

confidence: 99%

High-flow priapism due to bilateral cavernous artery fistulas treated by unilateral embolization: A case report

Guo¹,

Liu²,

Wang³

et al. 2023

World J Clin Cases

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“…El último paso diagnóstico será la arteriografía selectiva de la pudenda, que objetivará la extravasación de con-traste al cuerpo cavernoso desde el sistema arterial. Esta prueba nos permitirá también demostrar la bilateralidad o no del proceso, pero solo debemos realizarla como paso previo a la embolización y no como método diagnóstico 9 .Última-mente algunos autores han utilizado para el diagnóstico, la CT sin contraste 10 o la angio-resonancia 11 . De entre los varios tratamientos propuestos, algunos autores aconsejan, una vez realizado el diagnóstico, la conducta expectante, y lo hacen porqué sus casos se solucionaron con esta pauta 12,13 .…”

Section: Discussionunclassified

Nuestra experiencia en el priapismo de alto flujo por fistula arterio-lacunar uni y bilateral

et al. 2007

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RESUMEN NUESTRA EXPERIENCIA EN EL PRIAPISMO DE ALTO FLUJO POR FÍSTULA ARTERIO-LACUNARUNI Y BILATERAL Objetivo: Presentar nuestra experiencia en el priapismo de alto flujo tanto uni como bilateral, resaltando los buenos resultados obtenidos con la embolización supraselectiva.Material y método: Presentamos 5 casos de priapismo de alto flujo secundarios a traumatismo perineal, con una edad media de 31 años (24-43 a). El tiempo medio de consulta desde el momento del traumatismo fue de 18,6días (1-60 d). El diagnóstico se confirmo mediante gasometría de los cuerpos cavernosos, eco-doppler peneano (2 casos) y arteriografía selectiva de la pudenda. En todos los casos el tratamiento fue la embolización supraselectiva con esponja de gelatina. En los dos casos bilaterales la embolización se realizo en el mismo acto.Resultados: A corto plazo fueron la recuperación de la flacidez y a largo plazo (3-4 meses) la recuperación de la erección sin secuelas fibróticas de los cuerpos cavernosos en todos los casos.Conclusiones: La embolización de la arteria lacerada, y en caso de que sea bilateral en un solo tiempo, reporta excelentes resultados.Palablas clave: Priapismo de alto flujo. Fístula arterio-lacunar. Embolización. ABSTRACT OUR EXPERIENCE IN HIGH-FLOW PRIAPISM DUE TO UNI-OR BILATERAL ARTERIO-LACUNARFISTULA Objective: To present our experience in both uni-and bilateral priapism, highlighting good results obtained with supraselective embolisation.Material and methods: We present 5 cases of high-flow priapism secondary to perineal trauma, with a mean age of 31 years (24-43 years). The mean time to presentation from the moment of the trauma was 18,6 days (1-60 days). Diagnosis was confirmed through gasometry of the corpora cavernosa, penile doppler ultrasound (2 cases) and selective arteriography of the pudendal artery. In all cases treatment was by supralective embolisation with gelatin sponge. In the two bilateral cases, embolisation was performed in the same act.Results: In the short term was a recovery of flaccidity and in the long term (3-4 months) a recovery of erection with no fibrotic sequelae of the corpora cavernosa.Conclusions: Embolisation of the lacerated artery, in a single procedure in cases of bilateral lacerations, provides excellent results. Rodriguez Tolrá J et al./Actas Urol Esp. 2007;31(2):113-119 C lásicamente el priapismo se conoce como una erección peneana persistente y dolorosa, limitada a los cuerpos cavernosos y sin estar asociada al deseo sexual. Hay dos clases de priapismo. El mas conocido es el de bajo flujo o venoso, llamado así porqué hay un compromiso del retorno venoso que ocasiona hipoxia y una acidosis, que en último termino serán los responsables de la muerte celular y la posterior fibrosis. El otro tipo de priapismo es el denominado de alto flujo (termino que introdujo Hauri en 1983 1 .y que tiene su causa mas frecuente en un traumatismo perineal o peneano con la consiguiente laceración de la arteria cavernosa o de una se sus ramas y la aparición de una fístula arterio-lacunar 2,3 , no ...

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“…Enhanced CT or CT angiography can be non-invasively and quickly performed, and these are secondary recommended examinations for non-ischemic priapism. In addition, localization of arteriocorporeal fistulas within the corpora cavernosa and the presence of other pelvic injuries can be determined [ 16 ].…”

Section: Differential Diagnosismentioning

confidence: 99%

Clinical Management of Priapism: A Review

Shigehara

Namiki

2016

World J Mens Health

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Priapism is defined as a persistent and painful erection lasting longer than four hours without sexual stimulation. Based on episode history and pathophysiology, priapism is classified into three subtypes: ischemic (low-flow), non-ischemic (high-flow), and stuttering priapism. Ischemic priapism is characterized by a persistent, painful erection with remarkable rigidity of the corpora cavernosa caused by a disorder of venous blood outflow from this tissue mass, and is similar to penile compartment syndrome. Stuttering priapism is characterized by a self-limited, recurrent, and intermittent erection, frequently occurring in patients with sickle cell disease. Non-ischemic priapism is characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. Because ischemic and non-ischemic priapism differ based on emergency status and treatment options, appropriate discrimination of each type of priapism is required to initiate adequate clinical management. The goal of management of priapism is to achieve detumescence of the persistent penile erection and to preserve erectile function after resolution of the priapism. To achieve successful management, urologists should address this emergency clinical condition. In the present article, we review the diagnosis and clinical management of the three types of priapism.

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Post‐traumatic high flow priapism: Demonstrable findings of penile enhanced computed tomography

Cited by 14 publications

References 35 publications

High-flow priapism due to bilateral cavernous artery fistulas treated by unilateral embolization: A case report

High-flow priapism due to bilateral cavernous artery fistulas treated by unilateral embolization: A case report

Nuestra experiencia en el priapismo de alto flujo por fistula arterio-lacunar uni y bilateral

Clinical Management of Priapism: A Review

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