Selective arterial embolization of idiopathic priapism

Abstract

We report a case of idiopathic priapism that was only identified as high-flow or arterial priapism after drainage of the corpora cavernosa. Following failure of conservative and surgical treatment attempts, two consecutive embolizations of a unilateral penile artery were performed with gelgoam particles.

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

“…Given that blood gas analysis confirmed high‐flow priapism prior to creation of a surgical corporoglanular shunt, it is unlikely to represent a surgical complication. Other authors have theorized that ischaemic necrosis of the penile vasculature during prolonged ischaemic priapism may convert it to the high‐flow variety, which would explain the hypertrophy of common penile arteries and early arterial cavernosal blush/shunting in this case …”

“…There are very few cases of non‐traumatic high‐flow priapism reported in the literature . Previous authors have reported cases of high‐flow priapism following shunting procedures for ischaemic priapism; however, these typically have an angiographic lesion at the site of the surgical shunt .…”

Superselective Microcoil Embolization of a Traumatic Pseudoaneurysm of the Cavernosal Artery

“…Mourikis/Chatziioannou/Konstantinidis/ Panourgias/Antoniou/Vlachos tologous blood clot was the embologenic agent of choice in the majority of these patients [1,[3][4][5][6][7][8][9][10][11][12]. Gelfoam particles or slurry was used in some patients for temporary occlusion [5][6][7] while n-butyl-cyanoacrylate has been injected in 3 men [8].…”

“…In our case the priapism was not due to a 'high-flow' state since an arteriosinusoidal fistula was not recognized on Doppler or arteriography. At least 36 patients with arteriosinusoidal fistula, almost exclusively secondary to local trauma, have been treated with selective embolization and a cumulative success rate of greater than 90% [3][4][5][6][7][8][9][10][11]. Au-…”

“…Several reports in the past described the management of such fistulas with selective embolization by using autologous clot, gelfoam pledgets, n-butyl-cyanoacrylate or more recently, microcoils [4][5][6][7][8][9]. In a recent article, Kang et al [10] report the therapeutic embolization of a pseudoaneurysm of the cavernosal artery in 3 cases, all of which occurred simultaneously with traumatic arteriovenous fistula.…”