Traumatic High-flow Priapism Research Articles

Selective arterial embolization for a high-flow priapism following perineal trauma in a young gymnast

High-flow priapism is a rare condition in children, usually due to a perineal trauma. We present a case of traumatic highflow priapism investigated by Doppler ultrasound and managed by angiography and selective embolization of a branch of the internal pudendal artery. A 13-year-old gymnast underwent perineal trauma during training and developed a high-flow priapism. The first ultrasound (immediately after the trauma) showed the presence of an inhomogeneous area of 3 x 2 cm associated with an anechoic vascularized area (pseudoaneurysm) in the right corpus cavernosum. On the left side there was a similar finding, but of smaller size. After 3 weeks the pseudoaneurysm on the left was completely obliterated while the right one was still present. Angiography and superselective catheterization of a branch of the left pudendal artery and its embolization with microspheres and with metal microcoils were performed. After the procedure, ultrasound showed that the right pseudoaneurysm was completely obliterated and there were no more branches reaching it. The cavernous arteries were both pervious. Selective arterial embolization is a safe treatment that can also be used in pediatric patients.

Commentary on high flow, non-ischemic, priapism.

High-flow, non-ischemic priapism is a rare condition, with which many urologists and andrologists are unfamiliar. There are three types of high-flow priapism: traumatic, neurogenic and post-shunting. Traumatic high-flow priapism may arise from penetrating or blunt trauma to the penis resulting in rupture of the cavernous artery or its branches. Despite the unregulated large arterial flow, this does not result in rigid and painful erections, as seen in low-flow, ischemic priapism, because the venous channels are still competent. The neurogenic type is seen after irritation or injury to the central nervous system, and this is typically self-limiting. If this type persists, then it may change to ischemic priapism, and should be treated accordingly. Post-shunting high-flow priapism is a result of reactive hyperemia in response to the hypoxic and acidotic state of ischemicpriapism that lasts more than 24 hours. This condition will continue only if the shunt remains open. Once the hyperemic state subsides, the minimal flow in the flaccid penis will not be able to keep the shunt open leading to its spontaneous closure in most cases. In general, since blood circulation into and out of the corpora cavernosa is not impeded in cases of high-flow priapism, the condition is not painful, the penis is not completely rigid, and the prognosis is excellent if it is treated properly.

A POPULATION-BASED ASSESSMENT OF PERIOPERATIVE MORTALITY AFTER CYSTECTOMY FOR BLADDER CANCER

Traumatic high-flow priapism caused by a pathologic influx from lacerated arteries to the cavernous bodies is usually treated by transcatheter arterial embolisation. The purpose of this study was to evaluate a combined interventional approach with intraoperative perineal colour Doppler ultrasound (US) while performing the embolisation procedure. Our aim was to reduce radiation exposure and application of iodinised contrast media. To achieve an optimal position of the angiography catheter directly before or in the fistula, instead of several x-ray examinations with contrast media, a perineal colour Doppler US examination was performed while saline or US contrast media were injected through the catheter. The flow pattern allows the assessment of the occlusion of the fistula and the intact flow in the arteries that were not damaged. In four patients (unilateral fistula: 1, bilateral fistulas: 3) with traumatic high-flow priapism, this technique was performed combined with a conventional angiographic control of the embolisation. Seven embolisation sessions were performed. Only in one case, a dislocation of a microcoil required a second session. In all cases, the priapism disappeared immediately after the final session, leading to a restored erectile function. This combined approach may reduce the exposure to radiation and contrast media, especially in children, who often suffer from multiple fistulas and need more than one session. The procedure also prevents an occlusion of intact arteries that affects the penile perfusion and increases the risk of erectile dysfunction. (E-mail:[email protected])

Priapisme à haut débit non traumatique : traitement par embolisation artérielle

Purpose To report cases of non traumatic high flow priapism treated by arterial embolization. Material and methods Six men presented with non traumatic high flow priapism, the diagnosis was based on colour Doppler ultrasound, cavernous blood gas analysis with arterial blood saturation levels and failed medical or surgical therapy. Four patients had sickle cell disease. The embolization was performed with Gelfoam and was unilateral in one case, bilateral in the other cases. Results Detumescence occurred in a few hours in all cases. One patient had recurrent priapism two years after and was treated by embolization. Transient erectile dysfunction was observed in five cases, permanent in one case. Conclusion Arterial embolization is the treatment of choice in high flow priapism with low rate of permanent erectile dysfunction.

An alternative noninvasive approach for the treatment of high-flow priapism in a child: duplex ultrasound–guided compression

We are presenting a 5-year-old boy with a traumatic high-flow priapism developed after a straddle injury and successfully treated by compression and simultaneous monitoring with a duplex ultrasound probe. We believe that this may be an alternative method against conventional treatment modalities including conservative follow-up, sympathomimetic drug administration, percutaneous embolization of the fistula, and surgical ligation.

Treatment of “High-Flow” Priapism with Superselective Transcatheter Embolization: A Useful Alternative to Surgery

To review the efficacy of treatment of high-flow priapism with superselective transcatheter embolization. Over a 2-year period, we reviewed five patients who were treated for traumatic high-flow priapism with superselective embolization. All patients underwent diagnostic angiography that demonstrated a communication between the cavernosal artery and the corpora cavernosa. Each identified fistula was embolized using gel-foam, blood clot, microcoils, or a combination of these. All five patients had successful detumesence of priapism postprocedure. There was normal recurrence of early morning erection with successful detumescence for each patient within a 2- to 4-week period. Two of five patients (40%) presented with recurrence of priapism at 6 months and required a repeat embolization procedure. At 1 year, four of the five patients (80%) had normal erectile function. Superselective transcatheter embolization is a useful therapeutic modality in the treatment of high-flow priapism. It provides equivalent rates of detumesence when compared to surgical techniques, and appears to have a greater success in preserving erectile function.

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

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.

Interventional treatment of traumatic priapism.

To describe the effectiveness of transarterial embolization of traumatic priapism. Six patients ranging in age from 6 to 37 years with traumatic high-flow priapism underwent superselective embolization with gelatin sponges (n=3) or minicoils (n=3). Embolization was repeated up to 3 times. Embolization was successful in all cases. In 2 patients, repeated embolization led to a flow reduction in the fistula, which spontaneously occluded a few days later. All patients experienced normal erections after intervention, and no side effects were observed. Transarterial superselective embolization is an effective and well-tolerated therapy in patients with traumatic priapism.

High-flow priapism: a combined interventional approach with angiography and colour Doppler

Traumatic high-flow priapism caused by a pathologic influx from lacerated arteries to the cavernous bodies is usually treated by transcatheter arterial embolisation. The purpose of this study was to evaluate a combined interventional approach with intraoperative perineal colour Doppler ultrasound (US) while performing the embolisation procedure. Our aim was to reduce radiation exposure and application of iodinised contrast media. To achieve an optimal position of the angiography catheter directly before or in the fistula, instead of several x-ray examinations with contrast media, a perineal colour Doppler US examination was performed while saline or US contrast media were injected through the catheter. The flow pattern allows the assessment of the occlusion of the fistula and the intact flow in the arteries that were not damaged. In four patients (unilateral fistula: 1, bilateral fistulas: 3) with traumatic high-flow priapism, this technique was performed combined with a conventional angiographic control of the embolisation. Seven embolisation sessions were performed. Only in one case, a dislocation of a microcoil required a second session. In all cases, the priapism disappeared immediately after the final session, leading to a restored erectile function. This combined approach may reduce the exposure to radiation and contrast media, especially in children, who often suffer from multiple fistulas and need more than one session. The procedure also prevents an occlusion of intact arteries that affects the penile perfusion and increases the risk of erectile dysfunction. (E-mail:bjoern.volkmer@medizin.uni-ulm.de)

HIGH FLOW PRIAPISM COMPLICATING VENO-OCCLUSIVE PRIAPISM: PATHOPHYSIOLOGY OF RECURRENT IDIOPATHIC PRIAPISM?

Of the several known forms of priapism veno-occlusive priapism is the most common.' High flow priapism is uncommon and usually follows trauma to the perineum.2 More than 20 cases have been reported and the majority of patients have been treated with angiographic embolization.2 Idiopathic recurrent priapism occasionally follows treatment of veno-occlusive priapism and is a diagnostic and therapeutic challenge.3 We report on 2 patients with recurrent idiopathic priapism aRer treatment for veno-occlusive priapism. Diagnostic testing revealed a high flow cavernosal arterial state without evidence of a cavernosal-sinusoidal fistula. Arteriographic embolization with absorbable gelatin sponge resulted in complete resolution. This high flow state may represent a variant of traumatic high flow priapism or it may be the pathophysiology of recurrent idiopathic priapism and may be best treated with angiographic embolization. CASE REPORTS Case 1. A 33-year-old black man with no medical history presented with a painful erection 24 hours in duration. He denied any drug use and had no history of trauma or sickle cell disease. Corporeal aspiration revealed dark crankcase oil like blood. He was initially treated with intracorporeal imgation using saline and then 2 to 3 doses of 300 pg. phenylephrine, which resulted in partial detumescence. However, the erection returned within 15 minutes. A Winter shunt procedure was performed without resolution of the priapism. A glans spongiosum to corpus cavernosum shunt (El-Ghorab shunt) was then created. The shunt provided for partial detumescence. The priapism returned 6 hours postoperatively. Color duplex ultrasound of the penis revealed a high flow state, which was most significant in the right cavernosal (68 cm. per second) and dorsal (63 cm. per second) arteries. An internal pudendal arteriogram revealed a common cavernosal trunk, originating from the right internal pudendal artery. There was no separate cavernosal artery originating from the left internal pudendal artery and no evidence of a cavernosal-sinusoidal fistula. Angiographic embolization of the cavernosal trunk with absorbable gelatin sponge pledgets resulted in immediate detumescence. The penis remained detumescent without any spontaneous erections 4 weeks after embolization. minutes the erection returned. A bedside Winter shunt pro

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.