Post-traumatic High-flow Priapism Research Articles

Post-Traumatic High-Flow Priapism: Accessory Pudendal Origin of Cavernosal Artery From External Iliac Artery - A Case Report.

High-flow priapism is an uncommon condition typically resulting from penile or perineal trauma, due to laceration of cavernosal artery. We present a case of 24-year-old male who presented with post-traumatic painless priapism. Ultrasound showed hematoma with arterio-cavernosal fistula. On CT Angiogram, the cavernosal artery was seen arising from accessory pudendal artery, which arose from inferior epigastric artery (IEA), branch of external iliac artery (EIA). Catheter angiogram of EIA showed fistulous communication at the base of the penis from a branch of IEA. Selective embolisation of the artery was done using 33% glue (n-butyl cyanoacrylate). Post embolisation, no residual filling of the fistula and partial detumescence of penis was noted. Transarterial embolisation is usually preferred as first line of management in high-flow fistulous priapisms.

Post-traumatic high-flow priapism: uncommon presentation with endovascular management

A 24-year-old young man presented to hospital with a history of persistent penile erection associated with mild pain. He sustained a blunt trauma to the pelvis 3 weeks back following...

Successful management of post-traumatic high flow priapism by super selective coil embolization: A case report

Successful management of post-traumatic high flow priapism by super selective coil embolization: A case report

Ethylene-vinyl alcohol copolymer (Onyx®) transarterial embolization for post-traumatic high-flow priapism

We report a case of high-flow priapism treated successfully with superselective embolization of the cavernous artery. A 16-year-old male developed post-traumatic priapism subsequent to a fall causing blunt perineal trauma. He presented to our hospital four days after trauma. Immediately after the injury, he suffered painless sustained incomplete erection. High-flow priapism was diagnosed on the basis of color doppler ultrasonography findings. Computed tomography scan showed a high-flow arterio-venous fistula with feeders from branches of the right internal iliac artery. Selective arteriography of the right internal pudendal artery demonstrated an arterio-cavernous fistula. The fistula was superselectively embolized with ethylene-vinyl alcohol copolymer (Onyx(®)) liquid agent and disappeared completely. Improvement was noted, with significant detumescence on table. This was later confirmed on repeat color Doppler imaging. At follow-up 3 months later, he had normal erectile function. To our knowledge, transarterial embolization of high-flow priapism with Onyx(®) has never been reported and appears to be a safe and effective treatment for managing patients with such a condition.

Post-traumatic High-flow Priapism: Multidetector Computed Tomography Demonstration

High-flow priapism due to pseudoaneurysm is a relatively rare urologic condition. Clear anatomic delineation of the number and origin of feeding vessels facilitates pre-embolization planning. Computed tomographic angiography can afford a three-dimensional display of the feeding vessels. We present a 26-year-old man with post-traumatic high-flow priapism, which is the first case studied with computed tomographic angiography.

혈관색전술로 치료된 외상 후 발생한 고혈류성 음경발기지속증

Priapism, persistent erection without sexual arousal, can be classified into low-flow (venous or ischemic) and high-flow (arterial or non-ischemic). Perineal trauma is one of the most common causes of high-flow priapism. The clinical symptom of this disease is generally a prolonged, painless, and semi-rigid penile erection without any other urogenital symptoms. It can be confirmed by penile color Doppler ultrasonography and arteriography and it is usually treated by the super-selective embolization. We present a case of a 44-year-old man with a post-traumatic high-flow priapism as a result of the previous perineal trauma. After two-times of embolization by the autologous blood clot and the resorptive gelatinous foam, he was successfully treated.

Post-Traumatic High-Flow Priapism Treated with Gelatin Sponge Embolization: A Case Report

A 41-year-old male presented with a one week of ongoing priapism subsequent to an injury in a traffic accident (blunt perineal trauma). A selective arteriography of the right internal pudendal artery demonstrated an arterio-corporal fistula. A 2.8 French (2.8 Fr.) Renegade Microcatheter (Boston Scientific) was advanced proximal to the fistula over a 0.014 flexible guidewire. The fistula was then embolized with a gelatin sponge (gelfoam). Post embolization showed the closure of the fistula and significant detumescence. At 12 weeks later: there was no recurrence of priapism and the patient reported normal erectile function. Transarterial embolization appears to be a safe and effective treatment for managing patients with high-flow priapism.

Chronic post-traumatic high-flow priapism treated with temporary gelatin sponge embolization

We report the case of a 26-year-old man who presented with a non-painful priapism with a history of 3 months permanent erection after suffering a perineal trauma. An arteriocorporal fistula with a turbulent flow between the right cavernosal artery and the corpus cavernosum, conclusive for a high-flow priapism was initially detected by colour Doppler ultrasound. A superselective embolization with Gelatin sponge was safe and effective to treat the high-flow priapism. The use of gelatin sponge resulted in a temporary embolization with long-term effect of penile detumescence and preservation of erectile function.

Abstract No. 321: Posttraumatic high-flow priapism in pediatric patients treated with autologous blood clot embolization: Long-term results

Abstract No. 321: Posttraumatic high-flow priapism in pediatric patients treated with autologous blood clot embolization: Long-term results

Posttraumatic high-flow priapism in children treated with autologous blood clot embolization: long-term results and review of the literature

Usually high-flow priapism is caused by perineal or penile blunt trauma with direct cavernosal artery injury and formation of an arterial-lacunar fistula. Rarely, cavernosal artery injury may result from penetrating trauma. Treatment of high-flow priapism is not considered an emergency because patients are at low risk for permanent complications. For this type of priapism there are several options for treatment including embolization or surgical ligation. To describe the technique of superselective transcatheter embolization with the use of autologous blood clot and to discuss the long-term results. Seven children with a mean age of 10 years suffering from high-flow priapism were treated with superselective transcatheter embolization with autologous blood clot. In all cases, colour Doppler US was performed to demonstrate increased cavernous blood flow with definitive diagnosis established by superselective arteriography. After the angiographic diagnosis, superselective transcatheter embolization of the fistula with autologous blood clot was performed during the same session. The children were followed up on a monthly basis up to 1 year with clinical findings and penile colour Doppler US examinations. After 1 year, they were followed up annually with clinical assessment only. The mean follow-up period was 6.0 years. Following embolization complete detumescence was achieved in all but one child, who was treated with a second embolization 3 d after the initial session. In addition, for one child a second session of embolization was performed due to the recurrence of partial erection during the 1 week period after the initital embolization. In both cases, complete detumescence was achieved after the second embolization, and no recurrence of priapism was observed in the follow-up period. Selective arterial embolization with autologous clot achieved treatment for high-flow priapism in this study with 100% occlusion rate with a maximum of two sessions and no signs of erectile dysfunction were observed in any of the children during long-term follow-up.

Post-traumatic high-flow priapism treated by endovascular embolization using N-butyl-cyanoacrylate

BackgroundPriapism, persistent erection without arousal, can be classified into low-flow (venous or ischemic) and high-flow (arterial or non-ischemic). The diagnosis of high-flow priapism can be confirmed by colour Doppler and arteriography and it is usually treated by the endovascular embolization.Case reportWe present a case of a 20-year-old man with a post-traumatic high-flow priapism as a result of the previous perineal trauma. After a period of watchful waiting and an unsuccessful attempt at endovascular embolization using the resorptive gelatinous foam he was successfully treated by the endovascular embolization using N-butyl-cyanoacrylate.ConclusionsHigh-flow priapism can be successfully treated by the endovascular embolization, but the optimal choice of the embolization agent and a careful technique is essential.

Idiopathic Low-Flow Priapism in Prepuberty: A Case Report and a Review of Literature

Introduction. The incidence of priapism in adults is higher than in children. Although approximately 50% of all episodes of priapism are thought to be idiopathic, there are a number of known specific causes of this disorder. In adults intracavernous therapy with papaverine, phentolamine, alprostadil or combinations of these agents is the most common cause of ischemic priapism. In children the most common etiology is sickle cell anemia for low-flow priapism or post-traumatic high-flow priapism. We present a 13-year-old boy, not sexually active presented to our outpatient clinic suffering from long standing (3.5 hours) sustained painful erection. To the best of our knowledge the idiopathic low-flow priapism in pre-pubertal boy was not reported before in literature. Our case is the first case to be reported in pre-pubertal age. Conclusion. In pre-pubertal boys idiopathic recurrent priapism is a rare condition. In the literature, several empirical therapies are described. Recently, it is postulated that a low dose of a PDE5 inhibitor. The early conservative management is the best treatment option to safe the corporeal smooth muscles from irreversible damage.

Posttraumatic High-Flow Priapism in Children: Noninvasive Treatment by Color Doppler Ultrasound-Guided Perineal Compression

To our knowledge, only 1 case has been reported of high-flow priapism in boys younger than 6 years of age and only a small number of prepubertal boys have had high-flow priapism. Because of this, the diagnostic and therapeutic procedures are still under discussion. We report a case of a 3-year-old boy with posttraumatic high-flow priapism treated by ultrasound-guided compression of the arteriocavernous fistula.

Treatment of Posttraumatic High-Flow Priapism in 8-Year-Old Boy with Percutaneous Ultrasound-Guided Thrombin Injection

Treatment of high-flow priapism varies and has included transcatheter embolization when conservative approaches fail. We present the case of an 8-year-old boy with high-flow priapism, who was treated with ultrasound-guided thrombin injection because of encouraging experience with the method obtained when treating aneurysms and pseudoaneurysms. This procedure appears to be a useful alternative to transcatheter embolization and results in no radiation exposure.

Is the combination of superselective transcatheter autologous clot embolization and duplex sonography-guided compression therapy useful treatment option for the patients with high-flow priapism?

The aim of this study was to report feasibility, benefit and complications of superselective transcatheter autologous clot embolizations and duplex sonography-guided compression therapy in four patients with delayed post-traumatic high-flow priapism. Medical records of four consecutive patients diagnosed with delayed post-traumatic high-flow priapism (arterial priapism) were reviewed. High-flow priapism occurred mean 41.8 (6-92) h after the trauma developed. The patients were presented to hospital mean 8.3 (5-15) days after priapism occurred. The patients were assessed by penile color flow Doppler sonography. After the pathologically increased, arterial flow or arteriocavernosal fistula was seen, combination therapy with superselective transcatheter autologous clot embolizations and duplex sonography-guided compression was performed. If complete detumescence could not be achieved, this therapy was applied in the following day. In patients who had resistance to the second embolization, superselective embolization with microcoil was performed. Follow-up included penile color flow Doppler sonography at the following day, 1 month and 3 months after the procedure. International Impotence Symptoms Score (IIEF) was obtained during the follow-up. The treatment was successful in one, partially successful in one and not successful in two of the four patients. This therapy was reperformed to the latter three patients. After the treatment, high-flow priapism disappeared in one of the three patients and embolization with methalic microcoil was needed to perform to the other two patients. At 1 day after the treatment, color flow Doppler sonography and physical examinations were normal in all four patients. In the 1st and 3rd months of the follow-up, color flow Doppler sonography and the NPT tests were normal in three of the four patients. Slight erectile dysfunction was detected in one patient. Combination of superselective transcatheter autologous clot embolizations and duplex sonography-guided compression therapy may be considered as one of the first-line treatment options in adult patients with delayed post-traumatic high-flow priapism.

Juvenile posttraumatic high-flow priapism: Current management dilemmas

High-flow priapism results from disruption of the intercavernosal artery resulting in an arteriocavernosal fistula and is rarely encountered in the pediatric and adolescent population. Clinically it manifests as a painless, prolonged erection after perineal trauma. Treatment has ranged from expectant management to open surgical exploration with vessel ligation. Internal pudendal arteriogram and superselective embolization with autologous blood clot has emerged as a safe and effective treatment modality in the young male population. Here the authors present 3 patients with high-flow priapism and discuss management of this rare clinical entity.

High-flow priapism: colour-Doppler ultrasound-guided supraselective embolization therapy

High flow priapism is mainly caused by traumatic arteriocavernous fistulas. The standard therapy is a transcatheter embolization of the fistula. This study analyzes the combined approach of arteriography and color Doppler ultrasound during the embolization procedure. During the arteriography procedure, a perineal color Doppler ultrasound examination of the fistula was performed to achieve an optimal positioning of the catheter tip in the fistula with a minimum of radiation exposure. To visualize the correct localization, ultrasound contrast medium or saline solution was injected through the catheter. The flow-pattern of the contrast medium allowed evaluation of the successful occlusion of the fistula and preservation of the unaffected penile arteries. In six patients (unilateral fistula: three, bilateral fistulas: three) with a posttraumatic high-flow priapism, this technique was performed for embolization of the fistulas. A total of nine embolization sessions were performed. Only one case required a second session due to dislocation of a microcoil. In all cases, the priapism disappeared immediately after the final session while erectile function was restored within 4 weeks after embolization. The combined approach of x-ray and ultrasound imaging facilitates the supraselective embolization of the arteriocavernous fistula, leading to an optimal success rate, while reducing the radiation exposure and the applied dose of contrast medium.

Bilateral Superselective Arterial Microcoil Embolization in Post-Traumatic High-Flow Priapism: A Case Report

Priapism is a prolonged penile erection unrelated to sexual stimulation. High-flow arteriogenic priapism is uncommon and usually occurs after genitoperineal trauma, which may damage a feeding cavernosal artery, leading to an arteriovenous fistula and, occasionally, to an associated pseudoaneurysm. The defects rarely occur bilaterally. Herein, we report successful treatment of high-flow priapism secondary to a traumatic pseudoaneurysm fed from the bilateral cavernosal artery. Diagnosis was made after cavernosal blood gas analysis, color Doppler ultrasonography, and superselective angiography. Treatment consisted of superselective arterial embolization using metallic microcoils and resulted in simultaneous detumescence of the penis with no complications. The patient regained morning erection on the second postoperative day and erectile function remained normal 8 months after treatment. This case shows that bilateral arteriocavernosal fistulae can be successfully treated with superselective arterial embolization without affecting potency and highlights the importance of warning men about the possibility of developing high-flow priapism following a perineal trauma.

Priapismo de alto flujo postraumático infantil

AbstractWe report on the case of a post-traumatic high-flow priapism in a 14 year-old boy, wich was confirmed by cavernous blood gas measurement color flow Doppler sonography, and arteriography. It was successfully treated with superselective embolization of the right internal pudendal artery, resulting a clear disappearence of cavernus rigidity

Post-Traumatic High-Flow Priapism in a 6-Year-Old Boy

Post-Traumatic High-Flow Priapism in a 6-Year-Old Boy