Case Of High-flow Priapism Research Articles

A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review

BackgroundIn 2016, we reported the first case of high flow priapism and arteriocavernosal fistula caused by penile prosthesis insertion that mimicked device autoinflation. AimTo raise awareness amongst implanters, we describe further cases from our institution and perform a systematic review of the literature to understand the rarity of this phenomenon. MethodsPatient demographics, management and outcomes were extracted retrospectively. A systematic search of the EMBASE, PubMed and PubMed Central libraries for studies reporting arteriocavernosal fistula mimicking autoinflation since 1946 was performed. OutcomesTo identify and report all known cases of high flow priapism and arteriocavernosal fistula presenting as autoinflation of an inflatable penile prosthesis. ResultsFour patients in total (median age 56, range 46-60 years) were identified. Catastrophic bleeding (1.8L) occurred during revision surgery for presumed autoinflation in Patient 1 and subsequent ultrasound (US) confirmed a fistula which was embolized. Patient 2 redeveloped autoinflation following revision surgery. Ultrasound confirmed high flow priapism from an arteriocavernosal fistula. Patient 3 underwent penile magnetic resonance imaging (MRI) to investigate autoinflation and residual penile curvature. MRI showed a tumescent penis despite a deflated device and the fistula was embolized successfully. Patient 4 with sleep-related painful erections did not improve following insertion of penile prosthesis. Doppler US identified 2 fistulae that was embolized but with no resolution of symptoms. Subsequent embolization of both common penile arteries were done to control his symptoms. No other publications apart from the published abstract from 2016 reporting patient 1 was found. Clinical ImplicationsIf considered prior to revision surgery, the fistula can be managed safely by minimally invasive percutaneous angioembolisation avoiding surgery which can potentially be associated with significant complications. Strengths and LimitationsThe rarity of this phenomenon was supported by a systematic review. Our study however does present the findings from a small number of patients. ConclusionDamage to the cavernosal artery during inflatable penile prosthesis insertion can create an arteriocavernosal fistula that mimics autoinflation, leading to catastrophic intra-operative bleeding or unnecessary surgery.Lee WG, Satchi M, Skrodzka M, et al. A Rare Cause of Autoinflation after Penile Prosthesis Insertion: Case Series and Systematic Review. J Sex Med 2022;19:879–886.

High flow priapism in 7 years-old boy after accidentally consuming aphrodisiac chocolate: a case report

Non-ischemic priapism (high-flow) is a persistent erection caused by unregulated cavernous arterial flow, characterized by a painless, persistent nonsexual erection that is not fully rigid and is caused by excess arterial blood flow into the corpora cavernosa. The cavernous environment does not become ischemic and cavernous blood gas does not show hypoxia, hypercarbia, or acidosis. This case report aimed to present our experience of conservative treatments for the treatment of High Flow Priapism. A 7 year old boy presented with persistent nonpainful erections without sexual stimulation for 24 hours. Patient felt the erection since he had been woken up in the morning. Patient had consumed aphrodisiac chocolate accidentally 2 days before admitted to the hospital. There was no previous history of priapism, no previous history of trauma or other risk factors. Laboratory studies were within normal limits. Physical examination revealed a fully erect, nontender penile with rigid corpora cavernosa, soft glans, and erection hardness scale (EHS) 3. A cavernosal blood gas analysis was collected with the following values PH 7.41, pO2 117,7 mmHg, and pCO2 24,8 mmHg. Diagnosis of High Flow Priapism was made. He was observed and treated with conservative measures; ice and site-specific compression. After that EHS become 1. On follow-up at 2 months, parents reported normal erections with no further episodes of priapism. In this report, we present the first documented case of high flow priapism in a 7 years old boy after consuming accidentally aphrodisiac chocolate in Saiful Anwar general hospital.

High Flow Priapism in a Pediatric Patient after Circumcision with Dorsal Penile Nerve Block.

We report the first documented case of high flow priapism after circumcision with dorsal penile nerve block. A 7-year-old male who had undergone circumcision three years before presented to our institution with a 3-year history of persistent nonpainful erections. Workup revealed a high flow priapism and, after discussion of the management options, the patient's family elected continued observation.

Airborne Priapism: A Case of Nonischemic Priapism After Military Static-Line Parachute Injury

We report the case of a 21-year-old active duty U.S. Army soldier with painful and nonresolving priapism following blunt pelvic and lower extremity trauma from military static-line parachute injury during training. The patient's condition was initially managed with corporal aspiration and intracavernosal injections of phenylephrine that provided temporary relief but recurrence soon after. Referral to Urology at the site of the patient's injury yielded a diagnosis of penile hematoma. On subsequent evaluation by Urology on return to the patient's home duty station (over 96 hours after injury, with symptoms persisting), the corpora cavernosa were rigid, the corpus spongiosum was soft, and corporal blood gas drawn by the emergency department consistent with arterial blood. Penile duplex ultrasound revealed an isolated arterial-cavernosal fistula within the proximal left corporal body. The patient underwent percutaneous embolization of the fistula with successful resolution of his condition and return of normal erectile function. We discuss this unique case of high-flow priapism occurring after blunt trauma from military parachute injury and review suggested management in a stepwise fashion. The case is significant in that extensive literature review yields no previously described case of priapism following trauma from military parachute injury.

Therapeutic embolization of high-flow priapism 1 year follow up with color Doppler sonography

ObjectiveThe aim of this study was to evaluate the use of color Doppler sonography (CDS) for the diagnosis of high-flow priapism and the treatment of cavernosal arterial fistula via super-selective arterial embolization. Methods and materialsWe reviewed eight cases of high-flow priapism with cavernosal arterial fistula, from 2005 to 2011. All of the patients were diagnosed with a high-flow priapism and unilateral artery fistula via CDS. Conventional treatments for the eight cases were unsuccessful, and the patients were then treated through super-selective embolization. Diagnostic angiograms of the internal iliac artery showed a fistula on one side of the cavernosal artery, thus confirming the CDS images. We compared hemodynamic parameters including the peak systolic velocity, end diastolic velocity the resistance index of the pathological cavernosal artery and intracavernosal pressure in all patients before and after treatment using t-test. The efficacy of super-selective embolization and the erectile function of all patients were evaluated at a follow-up time of 12 months. ResultsAll patients were successfully treated and angiography showed that the fistulas disappeared after treatment. Additionally significant differences were found in the peak systolic velocity, the end diastolic velocity, the resistance index and intracavernosal pressure between pre-treatment and post-treatment (P<0.05). At 5 days post-treatment, only one case relapses had occurred. Seven cases displayed restored erectile function and only one case exhibited erectile dysfunction. ConclusionColor Doppler sonography is a highly sensitive method for the examination of high-flow priapism, and super-selective embolization is a safe and effective treatment for cavernosal arterial fistula.

SEXUAL FUNCTION AFTER HIGHLY SELECTIVE EMBOLIZATION OF CAVERNOUS ARTERY IN PATIENTS WITH HIGH FLOW PRIAPISM: LONG-TERM FOLLOWUP

We present 15 cases of high flow priapism treated by selective embolization and evaluate erectile function at long-term followup. Between 1995 and 2001, 15 patients underwent highly selective embolization of the cavernous artery for high flow priapism. Trauma was reported by 12 of the 15 patients, and no etiologic causes were evident in the other 3. The fistula was unilateral in 13 patients and bilateral in 2. All patients underwent embolization during arteriography. Erectile function was determined using the International Index of Erectile Function (IIEF) at followup after an average of 55 months (range 18 to 93). Postoperative color Doppler ultrasonography showed no recurrence in 11 patients (73%). Repeat pelvic angiography with selective embolization was required at 1 month postoperatively in 3 patients (20%). In 1 case (7%) 3 consecutive embolizations were not conclusive and a surgical operation was required. The IIEF results showed that sexual function was in the normal range in 80% of patients. Three patients (20%) reported a slight change in the quality of erection. Mean postoperative IIEF score was 26.3 (range 18 to 30). Highly selective embolization of the fistula is an effective and safe treatment option for high flow priapism because it ensures a high level of preservation of pretreatment erectile function.

Diagnosis and treatment of priapism: experience with 5 cases

Objectives. Priapism is a rare disease, but needs early intervention and appropriate management. We present 5 cases, 2 of nonischemic high-flow priapism and 3 of ischemic low-flow priapism.Methods. Focusing on the differential diagnosis of priapism between the nonischemic high-flow type and the ischemic low-flow type, we reviewed the medical records of 5 patients.Results. Of the examinations carried out, cavernosography, blood gas analysis of cavernosal blood, color Doppler ultrasound, and internal pudendal arteriography were useful in differentiating the type of priapism. Complete detumescence of the penis in 2 cases of high-flow priapism and 3 cases of low-flow priapism was achieved by selective embolization with gelform and by glandular-cavernosal shunting, respectively. No recurrence was observed in any patient, and postoperative erectile function was preserved in 4 patients and is unknown in 1.Conclusions. These results indicate that angiographic studies provide the most reliable information for the differentiation of the type of priapism. However, color flow Doppler ultrasound and cavernosal blood gas determination can obviate the need for angiographic studies and are noninvasive. Although conservative treatment or even expectant management may be feasible with high-flow priapism, aggressive treatment should be carried out for low-flow priapism immediately after initial treatment fails to achieve detumescence of the penis. Selective embolization of the internal pudendal artery may be the treatment of choice for patients with high-flow priapism.

High Flow Priapism Associated with Sickle Cell Disease

Priapism associated with sickle cell disease is classically described as a low flow state. We report 2 cases of high flow priapism associated with sickle cell disease. High flow priapism has previously been reported almost exclusively in patients with traumatic rupture of the cavernous artery. Neither of our patients had historical or radiographic findings consistent with injury to the penile vasculature. One patient was treated unsuccessfully with intracorporeal injection of methylene blue and 1 underwent successfully bilateral pudendal artery embolization. The pathophysiological mechanism(s) responsible for the production of high flow priapism in patients with sickle cell disease is not known.

Priapismo ad Alto Flusso: Diagnosi e Terapia. Descrizione di un Caso

We report a case of high flow priapism observed last year. The diagnosis was essentially made through anamnesis (trauma) and echography. Afterwards superselective arteriography of the pudenda right artery showed an afferent branch to the right corpus cavernosum and the artero-cavernosum fistula. After the catheterisation of this branch, using a Berenstein 5 F catheter, we proceded with the injection of non-absorbable embolising material. The echoDoppler emphasised disappearance of the biphasic flow and after 30 days the patient reported the spontaneous recovery in sexual relations. The corpus cavernosum biopsy, done 3 months later, showed a fair fibrosis.