Post-traumatic Priapism Research Articles

Diagnosis and X-ray endovascular methods of treatment of arterial priapism in children

Diagnosis and X-ray endovascular methods of treatment of arterial priapism in children

Endovascular Interventional Radiology of the Urogenital Tract.

Interventional radiology of the male urogenital system includes percutaneous and endovascular procedures, and these last consist mostly of transcatheter arterial embolizations. At the kidney level, arterial embolizations are performed mainly for palliative treatment of parenchymal tumors, for renal traumas and, less frequently, for arteriovenous fistulas and renal aneurysms and pseudoaneurysms. These latter may often require emergency intervention as they can cause renal or peri-renal hematomas or significant hematuria. Transcatheter arterial embolization is also an effective therapy for intractable severe bladder hematuria secondary to a number of neoplastic and inflammatory conditions in the pelvis, including unresectable bladder cancer and radiation-induced or cyclophosphamide-induced hemorrhagic cystitis. Endovascular interventional procedures for the penis are indicated for the treatment of post-traumatic priapism. In this article, we review the main endovascular radiological interventions of the male urogenital system, describing the technical aspects, results, and complications of each procedure at the various anatomical districts.

Posttraumatic High-Flow Nonischemic Priapism

Priapism is an uncommon disorder, and nonischemic priapism is seen less frequently in children, generally after trauma. Although it seems to be an advantage that urgent intervention is not required because of no cavernous ischemia, it is likely to be misdiagnosed because of the asymptomatic potential. We aimed to present a case of posttraumatic nonischemic priapism.

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.

Superselective Embolization in Posttraumatic Priapism with Glubran 2 Acrylic Glue

Two patients with posttraumatic priapism underwent transcatheter embolization using microcoils, resulting in temporary penile detumescence and an apparent resolution of the artero-venous fistula. In both cases, priapism recurred 24 hours after the procedure and was successfully treated through selective transcatheter embolization of the nidus using acrylic glue (Glubran 2). The patients showed complete recovery of sexual activity within 30 days from the procedure and persistent exclusion of the artero-venous fistula after a 12-month follow-up.

Color Doppler imaging of posttraumatic priapism before and after selective embolization.

High-flow priapism usually follows perineal or penile trauma with disruption of an intracavernosal artery. Angiographic embolization of the lacerated artery is currently considered the treatment of choice. The contribution of gray-scale and color Doppler ultrasonography (US) in diagnosis and treatment of 10 patients with high-flow priapism was investigated. In patients with recent arterial laceration, the cavernous tissue surrounding the arterial-sinusoidal fistula appears as a hypoechoic region with undefined margins. In long-standing priapism, this area is usually more regular and circumscribed, mimicking a pseudoaneurysm. Color Doppler US is highly sensitive for detection of the arterial-sinusoidal fistula that causes extravasation of blood from the lacerated cavernosal artery. After angiography, color Doppler US allows confirmation of both successful embolization by demonstrating disappearance or size reduction of the fistula and unsuccessful treatment by demonstrating patency of collateral feeding vessels or early recanalization of the embolized artery. Limitations of color Doppler US include underestimation of the number of accessory feeding vessels, which may become patent only after embolization of the main vascular supply, and difficulty in recognizing vessels that feed the fistula from the opposite side.

PREPUBERTAL HIGH FLOW PRIAPISM: INCIDENCE, DIAGNOSIS AND TREATMENT

We reviewed the literature of the last 40 years and report our experience with treating high flow priapism with fistula embolization in prepubertal boys. Two boys had blunt perineal trauma and 1 had penile trauma (ages 6, 6 and 10 years). Painless priapism developed within 24 hours and lasted for 4 to 7 days before the patients presented to the hospital. Primary diagnosis was made on color Doppler ultrasound. When high flow priapism was diagnosed angiography of the internal iliac artery and embolization of the arteriocavernosal fistula were performed. Mean followup was 26 months. Color Doppler ultrasound revealed bilateral arteriocavernosal fistulas in 2 boys and a unilateral fistula in 1. Angiography showed fistulas of the branches of the internal pudendal artery in 2 patients and fistulas of the bulbourethral artery in 1. Microcoils were used in the bulbourethral artery and a gelatin sponge was used in other penile arteries. Complete detumescence with restored erectile function was achieved in all cases. High flow priapism in children can be diagnosed easily by typical clinical features combined with color Doppler ultrasound. In children with posttraumatic priapism embolization of the arteriocavernosal fistula is superior to surgical or medical procedures and should be the first line therapy. Embolization using microcoils for bulbourethral arteries and a gelatin sponge for other penile arteries has proved to be safe and successful therapy.

Autoembolización espontánea en un niño con priapismo postraumático de alto flujo

There are two sort of priapism: the venous or low flow priapism, that is usually painful, and the arterial or high flow one, painless and rare, especially in childhood. We present a case of a boy 5 years old, who 6 days after to suffer a perineal closed traumatism, had a painless and arterial priapism, with aneurism and fistula of the dorsal penile arteria, that was resolute spontaneously through self-embolization, 11 days after. We review the bibliography of 14 cases of arterial posttraumatic priapism in childhood, without find any case resolute by spontaneous self-embolization.

Post-Traumatic Arterial Priapism: Colour Doppler Examination and Superselective Arterial Embolization

Purpose : To evaluate selective embolization for management of post-traumatic priapism and colour Doppler sonography for the diagnosis of the causative lesion and for planning embolization. Materials and Methods : Six male patients with post-traumatic priapism underwent selective angiography and embolization. Colour Doppler sonography with grey-scale was performed in all six patients before angiography. Results : Selective angiography showed intracavernosal arteriovenous fistulas in all patients and pseudoaneurysm of the cavernosal artery (or common penile artery) in three patients. After successful embolization, detumescence was achieved in all patients. Colour Doppler sonography enabled localization and characterization of the lesion causing priapism in four patients. Grey-scale ultrasonography showed the dilated cavernosal sinuses in all patients. Conclusion : Angiography with selective embolization is safe and effective method to correct post-traumatic priapism. Colour Doppler sonography with grey scale is a useful preangiographic study, as it allows for characterization and localization of the causative lesion except lesions at the proximal cavernosal or distal penile artery near the symphysis pubis.

Therapeutic Effectiveness of the Superselective Arterial Gelfoam Embolization in Post-traumatic ArterialPriapism

Purpose : We retrospectively evaluated superselective embolization with Gelfoam for the management ofpost-traumatic arterial priapism. Materials and Methods : Six male patients with post-traumatic priapism underwentpudendal angiography and embolization. We evaluated the time and incidence of detumescence after embolization andcompared normal erectile function and its duration with the results of other reports. In all patients, colorDoppler sonography was performed pre- and post-angiographically. Results : On pudendal arteriography,intracavernosal arteriovenous fistulas were observed in all patients, and pseudoaneurysm of the cavernosal artery(or common penile artery) in three. Detumescence and normal erec-tile function were achieved in all patients aftersuperselective embolization. Using color Doppler sonography, the location of the lesion causing priapism wasfound, in four patients, to be the proximal or middle one-third of the cavernosal artery. Conclusion : Pudendalangiography with superselective embolization with Gelfoam is a safe and effective method for the correction ofpost-traumatic arterial priapism.

Post-traumatic arterial priapism: Colour Doppler examination and superselective arterial embolization

To evaluate selective embolization for management of post-traumatic priapism and colour Doppler sonography for the diagnosis of the causative lesion and for planning embolization. Six male patients with post-traumatic priapism underwent selective angiography and embolization. Colour Doppler sonography with grey-scale was performed in all six patients before angiography. Selective angiography showed intracavernosal arteriovenous fistulas in all patients and pseudoaneurysm of the cavernosal artery (or common penile artery) in three patients. After successful embolization, detumescence was achieved in all patients. Colour Doppler sonography enabled localization and characterization of the lesion causing priapism in four patients. Grey-scale ultrasonography showed the dilated cavernosal sinuses in all patients. Angiography with selective embolization is safe and effective method to correct post-traumatic priapism. Colour Doppler sonography with grey scale is a useful preangiographic study, as it allows for characterization and localization of the causative lesion except lesions at the proximal cavernosal or distal penile artery near the symphysis pubis.

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.

Posttraumatic arterial priapism in children: management with embolization.

To evaluate selective embolization for management of posttraumatic priapism in preadolescent boys and color Doppler sonography for diagnosis of the causative lesion and for planning embolization. Five preadolescent boys with posttraumatic priapism underwent selective angiography and embolization. Color Doppler sonography was performed in the last three patients. Selective angiography showed an intracavernosal arteriovenous fistula in two patients, pseudoaneurysm of the cavernosal artery in two patients, and asymmetric cavernosal arterial flow in the other patient. After successful embolization, detumescence was achieved in all patients. Color Doppler sonography enabled localization and characterization of the lesion causing the priapism in the three patients. Angiography with selective embolization is a safe and effective method to correct posttraumatic priapism in children. Color Doppler sonography is a valuable preangiographic study, as it allows for characterization and localization of the causative lesion and obviates diagnostic cavernosal aspiration.

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.

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.

Post-traumatic Priapism Treated with Metaraminol Bitartrate

A 30-year-old male with post-traumatic priapism for 7 days was treated successfully by metaraminol bitartrate injection into the corpus cavernosum. This result suggests that an alpha-adrenagic agent injection into the corpus cavernosum should be considered in post-traumatic priapism at first.

Post-Traumatic Priapism

Review of 7 cases of post-traumatic priapism indicated that, despite the type of initial therapy, all patients expressed dissatisfaction with the total efforts, although erections were resumed. A surgical effort directed at drainage of fluid collections and correction of the ruptured tunic seems warranted and may aid the patients in further sexual activities.

A New Approach to the Treatment of Priapism

A 26-year-old man with post-traumatic priapism was treated successfully by occlusion of the left internal pudendal artery with an autologous clot. The recovery was marked by the return of entirely normal sexual function. This excellent result suggests that autologous clot injection of the internal pudendal artery should be considered as an appropriate form of therapy for the treatment of selected patients with priapism.