Superselective embolization for high-flow priapism refractory to medical and surgical treatments

Abstract

Background: This study aimed to report long-term outcome of superselective embolization in patients with highflow priapism refractory to medical and surgical treatments. Methods: From August 2011 until July 2016, 14 patients with high-flow priapism refractory to local treatments were treated and their charts were retrospective reviewed. Clinical evaluation, color Doppler ultrasonography, arteriography and selective embolization were performed. Follow up was performed in all patients. Fourteen men (18-63 years old) were enrolled, with priapism duration of 14 h to 28 days. Internal pudendal arteries or glutaea inferior arteriae were successfully embolized with gelatin sponge particles, polyvinyl alcohol particles or microcoils. Results: Pseudoaneurysm in right femoral artery was found in one case after intervention. The follow-up 1 week later showed that 13 patients were in good condition, the priapism diminished 1-7 days (mean 3.2 ± 0.5 days) after intervention, and 1 patient received second intervention. Mean follow-up was (range 10.8-69.6) months. One patient had recurrent priapism months after embolization and had his penis surgically removed for severe necrosis. Conclusions: Superselective embolization is safe and effective in high-flow priapism refractory local treatments, with a good long-term prognosis.

Effectiveness of Super-selective Embolization for Parasagittal Meningiomas and Its Effect on the Level of Inflammatory Factors

“…However, in conventional preoperative embolization, the embolization catheter can only reach the branch entrance of the external carotid artery, which suggests a high risk of surgical errors and may cause complications such as severe hemiparesis, aphasia, and coma. [ 22 ]. Super-selective embolization uses a microcatheter to avoid other normal arteries and protect the main trunk and major branches of the external carotid artery to reduce the incidence of complications such as local skin pain, numbness, fever, scalp necrosis, misembolization, and even cerebral infarction [ 23 , 24 ].…”

High-flow post-traumatic priapism with delayed presentation

“…A similar study presented in the literature with comparable demographics and case presentation required multiple serial embolisation that were ultimately unsuccessful and the patient was subsequently managed conservatively,3 while another study showed successful preservation of erectile dysfunction after a single embolisation 4. In a case series of 14 patients with high-flow priapism arterial embolisation was shown to be largely effective and safe with just one case of pseudoaneurysm resulting from femoral catheterisation and a one case requiring penectomy for penile necrosis after failed embolisations 5. However, the cases in this study were highly varied in demographics and aetiology with multiple older patients with underlying comorbidities.…”

“…High-flow priapism once diagnosed may be managed conservatively including pressure and cooling, surgically by ligating causative arteries or with arterial embolisation through interventional radiology 2. Although rare, several case reports describe the management of high-flow priapism through selective arterial embolisation using radiological guidance with variable patient outcomes 3–5…”