Super Selective Angioembolization for Posttraumatic ArterioCavernosal Fistula Presenting with Nonischemic Priapism

Abstract

Arteriocavernosal fistula generally occurs from penetrating injury and is rarely secondary to blunt trauma. Patients typically present with a painless partial erection following some type of genitoperineal trauma; the resultant arterial damage leads to an arterial-lacunar fistula and occasionally, to an associated pseudoaneurysm. The case reported in this article is unique in a way that the patient presented after 4 months yet super selective angioembolization of the feeder artery yielded promising results. A 24-year-old man was reported to the outpatient department of our center with a history of road traffic accidents and subsequent perineal injury 4 months back. The patient had complaint of inability to get full rigid erection and persistent partial erection of penis for 4 months since the trauma. On clinical examination, the patient had a partial detumescent penis and normal testes. Doppler ultrasonography revealed extravasation of blood from the lacerated cavernosal artery as a characteristic color blush that extended into the erectile tissue. Magnetic resonance imaging of the perineum suggested the possibility of left-sided posttraumatic arteriocavernous fistula. Diagnostic angiogram of left iliac artery demonstrated arteriocavernous fistula, and selective arterial embolization of feeding artery left cavernosal artery was performed with metallic coils. Procedure was uneventful. Complete detumescence was achieved in the immediate postoperative period. Super selective angioembolization of the feeder’s vessel remains the treatment of choice even in patients with long-standing fistula and priapism secondary to it.