Posttraumatic Nonischemic Priapism Treated with Autologous Blood Clot Embolization

Abstract

Introduction High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases. Aim To review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism. Main Outcome Measures Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism. Materials and Methods Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color–flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance. Results The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection. Conclusions Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure.

Acute management of priapism in men

“…The use of perineal and penile colour Doppler US to accurately localise the vascular lesion, makes external compression more precise [ 48,50 ] . However, these treatments may take days to weeks and are thus impractical [ 49 ] .…”

“…autologous clot or gelatine foam, are used. 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 ] .…”

Post-traumatic penile pseudoaneurysm causing high-flow priapism

“…This type of priapism requires immediate treatment as it is associated with ischemic penile necrosis and/or progressive fibrosis of the cavernosal tissues and erectile dysfunction [1,4]. Causes of ischemic priapism include hematologic disorders such as sickle cell anemia and leukemia [1].…”

Resistant pediatric priapism: A real challenge for the urologist

“…4 Recurrence rates are low (7%-27%). [12][13][14] Embolization in children, although successful, is technically challenging and requires treatment in a specialist pediatric vascular radiology department. 15,16 We report an interesting case of priapism, which was resistant to each treatment applied for the patient.…”