Idiopathic high‐flow priapism due to bilateral internal pudendal artery shunting

Davies, Nicholas; Nuwayhid, Fadi; Froelich, Jens J.

doi:10.1111/ans.12802

Cited by 2 publications

(2 citation statements)

References 7 publications

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“…There is potential concern for erectile dysfunction in the treatment of bilateral arteriocavernous fistulae particularly with the use of microcoils [2]. In order to attempt to avoid bilateral embolization, a previously reported case from Davies et al found adequate detumescence with unilateral embolization despite bilateral shunting [8]. Further reported attempts at unilateral embolization have not been as successful; the studies of both Lee et al and Gujral et al found that unilateral embolization resulted in return of symptoms shortly following the procedure [1, 9].…”

Section: Discussionmentioning

confidence: 99%

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Superselective Embolization with Microcoil and Gelfoam for High-Flow Priapism Secondary to Bilateral Cavernous Fistulae: A Case Study

Prattley

Bryant

Rees

2019

Case Reports in Urology

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Background. High-flow priapism is rare, and bilateral arteriocavernous fistulae formation following trauma is rarer still. Management of high-flow priapism is conservative either through observation, use of ice packs, mechanical decompression, or intracavernosal injection of α-adrenergic agonists, giving temporary results in selected cases. Alternatively, superselective arteriography with embolization is widely accepted. However, intervention needs to be mindful of the potential impact on long-term potency. We report the first case of bilateral arteriocavernous fistulae managed with both Gelfoam and microcoil embolization. Case Study. We present the case of a 35-year-old gentleman who attended the emergency department nine days following a fall from a moped, where he sustained bruising to his perineum, with persistent nonpainful erection. CT angiogram demonstrated bilateral arteriovenous fistulas. Management with superselective catheterisation and embolization with Gelfoam and microcoil was successful with resolution of symptoms. Long-term follow-up has shown return to normal erectile function twelve months following the injury. Outcomes. Concern regarding the effect to long-term erectile function has previously led to delayed bilateral embolization. Selection of embolization material can be tailored to the anatomical features of the fistula to help preserve function.

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Section: Discussionmentioning

confidence: 99%

“…Function following bilateral embolization for all patients appears to be excellent, with restoration of normal function in all cases within a year without the need for adjuncts [1, 8–10].…”

Section: Discussionmentioning

confidence: 99%

Superselective Embolization with Microcoil and Gelfoam for High-Flow Priapism Secondary to Bilateral Cavernous Fistulae: A Case Study

Prattley

Bryant

Rees

2019

Case Reports in Urology

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An Update on Non-Ischemic Priapism

Ingram

Stillings

Jenkins

2019

Sexual Medicine Reviews

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Introduction Non-ischemic or high-flow priapism is derived from unregulated arterial inflow within the penis, which is significantly less common and, therefore, less well characterized than ischemic or low-flow priapism. Aim We collected the most recent available data and summarized the findings. Methods All literature related to non-ischemic priapism from 2000–2018 from several databases was reviewed, and 105 articles, including any relevant referenced articles, were ultimately included. Main Outcome Methods We evaluated modality success rates, need for repeat procedures, and effects on erectile function. Results 237 cases of non-ischemic priapism were evaluated. Approximately 27% of patients underwent observation or medical management as the first treatment modality, whereas 73% underwent intervention without observation or medical management beforehand. Angiographic embolization with temporary agents was the most common intervention and generally resulted in both moderate resolution of non-ischemic priapism and moderate preservation of baseline erectile function. Patients who underwent embolization with permanent agents experienced higher rates of resolution, as well as lower rates of erectile dysfunction (ED). Conclusion Most of the literature is in the form of case reports and small case series, thus limiting the quality and quantity of evidence available to draw decisive conclusions. However, from the available data, it is reasonable to presume that patients can undergo a trial of conservative management, then pursue embolization first with temporary agents. The analysis of the data demonstrated ED rates were higher with temporary agents than permanent agents. The literature quotes ED rates as low as 5% when using temporary agents and 39% with permanent agents. Our results were, in fact, the opposite, with higher ED rates when using temporary agents vs permanent (17–33% vs 8–17%). Further studies are required to better characterize the success and outcomes of angioembolization.

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Idiopathic high‐flow priapism due to bilateral internal pudendal artery shunting

Cited by 2 publications

References 7 publications

Superselective Embolization with Microcoil and Gelfoam for High-Flow Priapism Secondary to Bilateral Cavernous Fistulae: A Case Study

Superselective Embolization with Microcoil and Gelfoam for High-Flow Priapism Secondary to Bilateral Cavernous Fistulae: A Case Study

An Update on Non-Ischemic Priapism

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