Abstract No. 394 - Non-invasive vascular imaging and endovascular therapy for non-ischemic priapism

Abstract

We aim to provide the reader with an educational depiction of the imaging findings and endovascular treatment options for non-ischemic priapism. A retrospective review of all the cases of non-ischemic priapism managed in our department in a period of 10 years: from August 2004 to August 2014. Specific examples of embolization cases were retrieved. We carried out a review of the current literature Non-ischemic (arterial, high-flow) priapism is usually the result of perineal or penile trauma. The injury results in a laceration in the cavernosal artery leading to the formation of a fistula between the artery and the lacunar spaces of the sinusoidal tissue. The diagnosis is usually made clinically and is aided by corporal blood aspiration and blood gas analysis. The role of non-invasive vascular imaging, both in diagnosis and in aiding conservative management (site specific perineal compression) is explored. Selective arterial embolization can be performed, usually after failure of conservative management. The relative merits of the different embolic agents used are summarised. The relevant angiographic anatomy is also presented. The operator must be familiar with the relevant anatomy including the critical variations which may necessitate alterations in technique. Non-ischemic priapism is a rare clinical entity that usually results from blunt trauma. Unlike ischemic priapism, it is not an emergency. Non-invasive vascular imaging can be performed to confirm the diagnosis and aid conservative management. Transarterial embolization can provide a definitive treatment in selected patients when conservative therapy has failed.