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.
Ilkay
A K
AK
Division of Urology (Department of Surgery), Cook County Hospital, Chicago, IL 60612, USA.
Levine
L A
LA
D000328:Adult; D000792:Angiography; D001158:Arteries / Q000293:injuries; D001783:Blood Flow Velocity; D004438:Ecchymosis / Q000209:etiology; D004809:Ephedrine / Q000627:therapeutic use; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply / Q000293:injuries*; D011317:Priapism / Q000209:etiology / Q000628:therapy*; D012039:Regional Blood Flow; D007507:Therapeutic Irrigation / Q000379:methods; D013927:Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D018615:Ultrasonography, Doppler, Color
D004809:Ephedrine