Posttraumatic nonischemic priapism treated with autologous blood clot embolization.
BACKGROUND
High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases.


OBJECTIVE
To review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism.


METHODS
Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism.


METHODS
Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance.


RESULTS
The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection.


CONCLUSIONS
Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure.
Numan
Furuzan
F
Department of Radiology, Division of Interventional Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
Cantasdemir
Murat
M
Ozbayrak
Mustafa
M
Sanli
Oner
O
Kadioglu
Ates
A
Hasanefendioglu
Aylin
A
Bas
Ahmet
A
D000293:Adolescent; D000328:Adult; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection; D010413:Penis / Q000098:blood supply*; D011317:Priapism / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011859:Radiography; D012039:Regional Blood Flow; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D016157:Vascular Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*