Treatment of “High-Flow” Priapism with Superselective Transcatheter Embolization: A Useful Alternative to Surgery

Abstract

Superselective transcatheter embolization is a useful therapeutic modality in the treatment of high-flow priapism. It provides equivalent rates of detumesence when compared to surgical techniques, and appears to have a greater success in preserving erectile function.

Percutaneous Direct Puncture Embolization with N-butyl-cyanoacrylate for High-flow Priapism

“…However, the recurrence of priapism is frequent because of premature lysis of the clots [8]. Recurrence rates of 30-40 % have been reported after treatment by selective embolization in high-flow priapism [7,9,10]. Therefore, multiple sessions of arterial embolization may be necessary within a month of the first arterial embolization.…”

“…Gelatin sponge is a temporary occlusive agent, thus permitting cicatricial closure of the arteriocavernosal fistula and subsequent re-channeling of the embolized artery [7]. Because of the temporary interruption of the blood flow feeding the fistula, it seems to represent an ideal embolic material.…”

Post-traumatic penile pseudoaneurysm causing high-flow priapism

“…If a cavernosal pseudoaneurysm is identified, ultrasound-guided compression of the pseudoaneurysm can be attempted. Following a period of 1 month, if conservative management fails, then transcatheter embolization of the pseudoaneurysm should be considered [3,5,8]. Fig.…”

Ethylene-vinyl alcohol copolymer (Onyx®) transarterial embolization for post-traumatic high-flow priapism

“…In brief, the guidelines recommend "observation" as an initial management of non-ischemic (high-flow) priapism. Immediate invasive interventions (embolization or surgery) are recommended to be carried out at the request of the patient (2,3). In response to the patient's request for treatment, selective arterial embolization is recommended as a second step management.…”

“…While the painful low-flow priapism and the associated decreased oxygenation of cavernous tissue can quickly lead to a cavernous fibrosis and permanent damage to penile tissues and is, therefore, an urological emergency, highflow priapism is often painless and can persist for months, in most cases without a permanent damage of penile tissues, but sometimes with the reduced potency. Transarterial embolization of the distal internal pudendal arteries is the treatment of choice for high-flow priapism and a useful alternative to surgery (1,2). However, the choice of embolic agent remains a debate of matter (3).…”