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.
Bartsch
Georg
G
Department of Urology, Faculty of Medicine, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany.
Kuefer
Rainer
R
Engel
Oliver
O
Volkmer
Bjoern G
BG
D004621:Embolization, Therapeutic; D006801:Humans; D008297:Male; D011317:Priapism / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D018615:Ultrasonography, Doppler, Color