Use of Magnetic Resonance Angiography in Diagnosis and Decision Making of Post-Traumatic, High-Flow Priapism

El‐Assmy, Ahmed; Hekal, Ihab A.; El-Ghar, Mohamed Abou

doi:10.1100/tsw.2008.35

Cited by 11 publications

(5 citation statements)

References 13 publications

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“…Usually, a period of several days between the injury and the onset of priapism can be explained by the formation of a physiological blood clot by the body after the injury that seals the damaged artery and can slough off. then in the edema and inflammation phase [7] . In fact, this was the natural progression of high-flow priapism in our case: 2 days after the injury, the patient was reported to have no symptoms except pain and ecchymosis of the genitals, on the third day the patient had continuous penile erection.…”

Section: Discussionmentioning

confidence: 99%

Endovascular intervention with high-flow priapism: A case report

Dung,

Loc,

Khuyen

et al. 2024

Radiology Case Reports

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Section: Discussionmentioning

confidence: 99%

Endovascular intervention with high-flow priapism: A case report

Dung,

Loc,

Khuyen

et al. 2024

Radiology Case Reports

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“…Therefore, for patients with clinical symptoms, hyper-selective angiography should be performed. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are effective for the preoperative diagnosis of urethral hemorrhage, [9] and thus, patients should be aggressively examined using CTA or MRA preoperatively if feasible (Fig. 3).…”

Section: Discussionmentioning

confidence: 99%

Embolization with microcoils for urethral hemorrhage

et al. 2019

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Rationale: Microcoils are a permanent embolic material, and blood vessels that have been embolized by a microcoil remain occluded for a prolonged period of time. The pudendal artery is an important functional vessel for penile erection. Whether simultaneous embolization of the bilateral pudendal artery using microcoils can seriously affect penile erection has not been sufficiently studied. Patient concerns: A 47-year-old male patient, after undergoing brain surgery, accidentally pulled out the Foley catheter causing a urethral hemorrhage. The patient was immediately treated using a new larger Foley catheter inserted under urethroscopic guidance and medication. However, massive bleeding occurred on the tenth day after the procedure. Diagnosis: A right internal iliac angiography performed after the bleeding event demonstrated a rupture at the end of the right internal pudendal artery with the contrast agent flowing out directly from the urethra. A super selective internal pudendal angiogram showed a small amount of hemorrhage at the end of the left internal pudendal artery. Interventions: The patient underwent interventional treatment. After the bilateral internal iliac angiography was performed, super-selective internal pudendal artery embolization with microcoils was performed. A subsequent bilateral internal pudendal angiogram did not show any abnormality. Outcomes: During the follow up period of 2 months, the patient had no complaints of difficulty in urination or sexual dysfunction. Lessons: Some doctors do not advocate the use of coils as embolic agents in bilateral pudendal artery lesions because of concerns over erectile dysfunction. There is rich vascular circulation in the perineum. Thus, in arterial embolization for the treatment of penile bleeding, regardless of the type of embolic material used, the key is to ensure accurate embolization to maintain good collateral circulation. This principle can help limit the occurrence of sexual dysfunction to the lowest possible levels after such procedures.

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“…MRI has been increasingly used to image several penile disorders, including neoplasms, fractures and Peyronie’s disease, providing good anatomical images and delineation between tissue planes [5,6]. Penile MRI has to date not been routinely used in cases of priapism, although it has been reported in high‐flow priapism [8] and in difficult diagnostic cases of low‐flow priapism [9,10]. In cases of ischaemic priapism where there have been several interventions, traditional Doppler US can be difficult to interpret, and has questionable accuracy.…”

Section: Discussionmentioning

confidence: 99%

The use of high‐resolution magnetic resonance imaging in the management of patients presenting with priapism

Ralph¹,

Borley²,

Allen³

et al. 2010

BJU International

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Study Type – Diagnosis (exploratory cohort) Level of Evidence 2b OBJECTIVE To investigate the use of magnetic resonance imaging (MRI) of the penis during an episode of priapism and assess the viability of the corpus cavernosum (CC) smooth muscle, as prolonged ischaemic priapism is associated with a high rate of long‐term erectile dysfunction (ED), and the viability of CC smooth muscle influences the subsequent management in ischaemic priapism. PATIENTS AND METHODS The study was set in a single centre based in a large university teaching hospital. We investigated the correlation of T2‐weighted gadolinium‐ enhanced MRI with the histology from CC biopsies in the same patients. In all, 38 patients (mean age 42 years) presenting with priapism over a 3‐year period had MRI of the penis. The scans were reported by two dedicated uro‐radiologists who graded the MR images as showing viable or nonviable erectile tissue. One pathologist assessed the CC biopsies for necrosis. The findings were then correlated. Where no biopsies were taken a clinical follow‐up was used to assess erectile function. RESULTS In 23 patients undergoing both a CC biopsy and MRI, the sensitivity of MRI in predicting nonviable smooth muscle was 100%. In a further 10 patients MRI showed nonviable CC smooth muscle, but no biopsy was taken in these patients; on clinical follow‐up all of these patients subsequently developed ED. In a further five patients the imaging showed viable smooth muscle and these patients subsequently maintained erectile function on clinical follow up. CONCLUSIONS Penile MRI provides an accurate imaging method to assess smooth muscle viability in patients presenting with priapism.

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Use of Magnetic Resonance Angiography in Diagnosis and Decision Making of Post-Traumatic, High-Flow Priapism

Cited by 11 publications

References 13 publications

Endovascular intervention with high-flow priapism: A case report

Endovascular intervention with high-flow priapism: A case report

Embolization with microcoils for urethral hemorrhage

The use of high‐resolution magnetic resonance imaging in the management of patients presenting with priapism

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