High-flow Priapism Research Articles

Superselective Microcoil Embolization in the Management of High-Flow Priapism

Superselective Microcoil Embolization in the Management of High-Flow Priapism

Post-traumatic priapism treated with selective cavernosal artery ligation

Two cases of post-traumatic high-flow priapism after blunt trauma to the penis are presented. Diagnosis of high-flow priapism was accomplished with the use of both color-flow Doppler ultrasound and arteriography, which demonstrated arteriocorporal fistulas. In each patient, angiographic embolization was attempted but abandoned because the distal artery feeding the fistula could not be safely catheterized. Both patients were definitively treated with surgical ligation of the arteriovenous fistula, guided by intraoperative ultrasound. Operative management with arterial ligation provides a safe, selective, and effective alternative treatment to embolization. Two surgical approaches are discussed, one extracorporal and the other transcorporal. We believe that although transcorporal dissection poses increased risks, it is appropriate for arterial priapism of prolonged duration, especially if a well-formed vascular pseudocapsule is identified.

High-flow priapism associated with Fabry's disease in a child: A case report and review of the literature

We report a case of priapism in an 11-year-old boy known to have Fabry's disease. High flow was confirmed by color flow Doppler ultrasound and intracorporal blood gas measurements. Successful treatment was achieved by unilateral percutaneous Gelfoam embolization of the left internal pudendal artery. Previously reported cases of priapism associated with Fabry's disease were identified through a MEDLINE search of the English literature and review of the publications. Five reported cases of priapism associated with Fabry's disease were found, including those of 3 children. A report of a child with high-flow priapism that did not respond to conventional treatment including cavernovenous shunting was noted. Priapism associated with Fabry's disease may be caused by unregulated high arterial inflow. Early recognition of the underlying pathophysiology may identify those cases that would be amenable to percutaneous embolization therapy and may obviate the need to pursue other ineffective conventional treatments.

Perineal abscess after embolization for high-flow priapism

High-flow priapism is unusual and is most often due to blunt perineal trauma with resultant laceration of the cavemosal artery, creating an arteriocavernosal fistula. Although few cases have been reported, the consensus on management appears to be embolization of the fistula with autologous clot, alone or in combination with Gelfoam. We present a case of high-flow priapism treated in this manner. The embolized pseudoaneurysm evolved into an abscess that eventually spread to the perineum. The rarity of this entity and the postprocedural morbidity are reported.

Priapism: etiology and management.

Priapism is a urologic emergency. All patients should receive prompt urologic consultation. Management is based on prompt recognition, differentiation between low- and high-flow priapism, reversal of any potential precipitating factors, and the use of corporal aspiration/irrigation combined with intracavernosal alpha-agonist injection therapy. It cannot be over-emphasized that severely prolonged erections are associated with the development of irreversible problems with erectile function and, therefore, immediate and aggressive management is mandatory.

Posttraumatic high-flow priapism treated by N-butyl-cyanoacrylate embolization

Posttraumatic high-flow priapism treated by N-butyl-cyanoacrylate embolization

Posttraumatic High-Flow Priapism Treated byN-Butyl-Cyanoacrylate Embolization

A patient with high-flow priapism was treated by transcatheter embolization of a posttraumatic left cavernosal arteriovenous fistula using N-butyl-cyanoacrylate (NBCA), resulting in complete detumescence. Erectile function has been preserved during a 3-month follow-up. Only two patients with NBCA embolization for high-flow priapism have been reported previously.

Evolving Concepts in the Diagnosis and Treatment of Arterial High Flow Priapism

Purpose We investigated 2 evolving concepts in the management of arterial priapism: 1) the efficacy of perineal duplex Doppler ultrasound as a diagnostic alternative to arteriography and 2) the therapeutic alternative of expectant management. Materials and Methods We evaluated 10 patients with high flow arterial priapism. Results Compared to selective internal pudendal arteriography, perineal duplex Doppler ultrasonography was associated with 100 percent sensitivity and 73 percent specificity rates. Compared to physical examination, followup duplex ultrasonography had a sensitivity of 75 percent and specificity of 100 percent. Followup penile duplex ultrasound demonstrated restoration of antegrade flow in the cavernous artery after embolization. Patients on expectant management remained potent as long as 31 years. Conclusions Diagnostic perineal duplex Doppler ultrasonography and expectant management are valuable tools for the treatment of arterial priapism. A new algorithm for patient care is presented.

Evolving Concepts in the Diagnosis and Treatment of Arterial High Flow Priapism

Evolving Concepts in the Diagnosis and Treatment of Arterial High Flow Priapism

SICKLE CELL DISEASE WITH HIGH AND LOW FLOW PRIAPISM TREATED WITH A MALLEABLE PENILE PROSTHESIS

SICKLE CELL DISEASE WITH HIGH AND LOW FLOW PRIAPISM TREATED WITH A MALLEABLE PENILE PROSTHESIS

Conservative management of high-flow priapism

High-flow priapism most frequently occurs as a result of penile trauma with subsequent unchecked arterial flow into the corpora cavernosa. An improved understanding of its underlying pathophysiology has allowed a more selective therapeutic approach, usually with preservation of potency. We report on 4 cases of traumatic high-flow priapism seen over a 5-year period. The patients were managed successfully with conservative treatment consisting of observation after arteriography or percutaneous duplex ultrasound-guided autologous clot embolization where tortuous vessels prevented selective embolization. No patient required surgical repair and hospitalization was brief (0 to 2 days). The use of color duplex ultrasonography provided a noninvasive modality for establishing the site of the injury and allowed serial follow-up evaluation. When conservative measures failed, the color duplex ultrasound study confirmed the presence of the ruptured cavernous artery and allowed percutaneous autologous clot embolization in 1 patient. Long-term follow-up (1 to 4 years) of these patients revealed a return to their preinjury state of erectile function. urology 46: 419-424, 1995.

Case report: High flow priapism diagnosed by colour Doppler flow mapping

Case report: High flow priapism diagnosed by colour Doppler flow mapping

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.

High Flow Priapism Associated with Sickle Cell Disease

High Flow Priapism Associated with Sickle Cell Disease

Use of Selective Embolization of the Bilateral Cavernous Arteries for Posttraumatic Arterial Priapism

Nonischemic arterial high flow priapism caused by traumatic laceration of a branch of the penile cavernous artery is rare. We report a case of laceration of the left and right branches of the intracavernous artery, which was confirmed by selective internal pudendal arteriography. Bilateral cavernous artery embolization was performed using gelatin sponge and detumescence occurred immediately. Normal potency was evident 4 months later. Our case demonstrates that selective cavernous arterial embolization is a safe and effective therapy for arterial priapism and that erectile function can return to normal.

Posttraumatic Priapism in a 7-Year-Old Boy

Priapism in childhood is most commonly a low-flow state due to sickle cell anemia. A high-flow priapism was seen in a 7-year-old boy following a straddle-injury-induced arteriocavernosal fistula. Penile aspiration, intracorporeal alpha-agonist injection and unilateral arterial embolization failed to resolve the priapism which eventually settled following a cavernosaphenous shunt.

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.

DIFFERENTIATION OF HIGH-FLOW AND LOW-FLOW PRIAPISM

DIFFERENTIATION OF HIGH-FLOW AND LOW-FLOW PRIAPISM

Delayed High Flow Priapism: Pathophysiology and Management

Two cases of the management and pathophysiology of high flow arterial priapism are presented. Both cases were post-traumatic with delayed onset of priapism and both had angiographically diagnosed arteriocorporeal fistulas. Case 1 was managed with selective cavernous artery ligation and case 2 resolved spontaneously, both with excellent return of premorbid levels of erectile function. We propose that the pathophysiological mechanism involves injury to the intracavernous artery, causing ischemic necrosis. After a delay the arterial segment blows out, leading to unregulated blood flow into the corpus cavernosum. Management with surgical ligation is highly selective and nondisruptive to unaffected vessels, offering precise control of the bleeding vessel.

Treatment of Post-Traumatic Priapism by Means of Autologous Clot Embolization

High-flow priapism is a quite uncommon event. The disease should be suspected on the basis of a referred trauma and/or by means of some laboratory findings. Nevertheless selective arteriography remains the only examination able to give us the final diagnosis. Autologous clot embolization allows complete resolution of the problem.