A comparison of the therapeutic efficacy of superselective arterial embolization and watchful waiting in high-flow priapism

Abstract

Objective Compare the efficacy of superselective arterial embolization with observation in the treatment of HFP caused by trauma. Methods From Jan, 2013 to Dec, 2017, 6 traumatic HFP patients were involved into the study, the age range from 18 to 44 years old, with an average age of 26.2 years. The fistula was measured by doppler ultrasonography before the treatment with its longest diameter, and which ranges from 0.8 to 1.4 cm, the average diameter is 1.14 cm. All patients are divided into two groups according to their treatment. Operation group: 4 patients underwent the pudendal artery superselective gelatin sponge vascular embolization. Control group: 2 cases were treated with local cold compressing under watchful waiting. In control group, patients are treated by local cold compress with ice bag for 3 weeks: 15 mins×10 times every day. The erectile hardness of the patients was observed and the fistula was evaluated by doppler ultrasonography 3 weeks later, and all the patients were reexamined by doppler ultrasonography 1 year later. The erectile hardness was divided into four grades according to the patient's subjective feelings: grade Ⅰ, the penis was enlarged but not rigid; grade Ⅱ, the penis had hardness, but not enough to insert into the vagina; grade Ⅲ, the penis could be inserted into the vagina, but not to achieve complete erection; grade Ⅳ, the penis fully erect and firm. The erectile function was evaluated with the International Index of Erectile Function-5(IIEF-5) after 1-year′s follow-up. Results 4 patients in the operation group were operated successfully without obvious complications after operation. Median follow-up time of all the patients was 21 months (5-50). In group operation, 4 cases of surgical patients did not have the recurrence of priapism. There was no obvious abnormality in the color doppler ultrasound of penis. The score of IIEF-5 was 25, 24, 24 and 23, respectively. Postoperative erectile function made a complete recovery. In group observation, 2 patients under watchful waiting still have gradeⅡ-Ⅲ sustained priapism, IIEF-5 score is 21 and 19 respectively, the penis color doppler ultrasound scan still showed the change of arteriovenous fistula. Conclusion Superselective arterial embolization is effective in the treatment of HFP, and the recovery of sexual function is better after operation compared with watchful waiting. Key words: Priapism; Artery embolization; Watchful waiting; Sexual function; Follow-up