Abstract
Priapism is an abnormal prolonged and persistent penile erection lasting more than 4 h, unrelated to sexual desire, stimulation or activity. The three types of priapism are low-flow, high-flow and stuttering. Patients with sickle cell disease (SCD) have increased risk of low-flow and stuttering priapism, but high-flow priapism is relatively uncommon in SCD. We report a case of non-traumatic refractory high-flow priapism evolving from a stuttering low-flow priapism in a patient with SCD. The patient was successfully treated by super-selective transcatheter embolization of the penile arteries with an autologous blood clot. It is proposed that the super-selective transcatheter embolization of unilateral or bilateral penile arteries with autologous blood clot is a relatively safe and effective non-surgical treatment option for high-flow priapism, even in patients with SCD, and has a low probability of developing erectile dysfunction.
Highlights
Priapism is an abnormal prolonged and persistent penile erection lasting for more than 4 h that is unrelated to sexual desire, stimulation or activity[1,2,3,4,5]
Stuttering priapism is ischemic in nature associated with multiple recurrent intermittent self-limiting episodes of persistent erection usually lasting less than 3–4 h and its commonest cause is sickle cell disease (SCD)[5]
We report a case of non-traumatic refractory high-flow priapism evolving from a stuttering low-flow priapism in a SCD patient
Summary
Priapism is an abnormal prolonged and persistent penile erection lasting for more than 4 h that is unrelated to sexual desire, stimulation or activity[1,2,3,4,5]. Each episode lasted for less than 2 h He presented with a sustained erection for 12 days duration in another facility, where he received treatment for low-flow priapism by repeated corporal aspirations and transfusion of 3 units of blood with no detumescence. After the failure of initial management by corporeal aspiration, the non-traumatic high-flow state was successfully treated using autologous blood clot embolotherapy. The autologous blood clot and gelatin foam have transient effect as embolization agents[20] and their use in high-flow priapism patients has the theoretical advantage of recanalization of penile arteries, as compared to platinum microcoils, to reduce the risk of permanent erectile dysfunction. There were no further episodes of priapism and he had adequate self-limiting erections for intercourse
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