Traumatic high-flow priapism: treatment with super-selective micro-coil embolization

Abstract

Priapism, a relatively uncommon disorder, is a prolonged penile erection not associated with sexual desire [1]. The term is derived from Priapus, the god of fertility in Greek and Roman mythology, who possessed a large phallus [2]. It is classified into two forms: low-flow or ischemic priapism and high-flow, non-ischemic priapism. Low-flow, the most common type, is due to a malfunction of normal veno-occlusive mechanisms resulting in outflow obstruction and high cavernous pressures. This severe decrease in venous drainage may lead to irreversible ischemic changes and permanent erectile dysfunction. High-flow priapism, far less common than the ischemic variant, involves unregulated cavernous arterial inflow. Patients typically present with a painless partial erection following some type of genito-perineal trauma; the resultant arterial damage leads to an arterial-lacunar fistula and occasionally, to an associated pseudoaneurysm. The current literature accounts for only a handful of case reports describing the use of micro-coils in the treatment of high-flow priapism [3–7]. We aim to report the case of a patient with moderately painful high-flow priapism, and the successful application of metallic micro-coils in embolization of a delayed traumatic arteriocavernosal fistula, associated with a pseudoaneurysm.