Color Doppler appearance of penile cavernosal-spongiosal communications in patients with high-flow priapism.
BACKGROUND
Superselective embolization of the torn artery is currently considered the treatment of choice for patients with high-flow priapism. After embolization, however, the arterial-sinusoidal fistula is still patent in a significant percentage of patients, despite arteriographic evidence of occlusion.


OBJECTIVE
To investigate the prevalence and flow characteristics of penile cavernosal-spongiosal communications (CSCs) in patients with high-flow priapism, and to establish whether the recognition of these vessels before and after angiographic embolization has a role in predicting the outcome of therapy.


METHODS
Twelve consecutive patients with high-flow priapism underwent penile color Doppler ultrasound before and after angiographic embolization of the arterial-sinusoidal fistula. The prevalence of CSCs feeding the fistula was evaluated before and after embolization.


RESULTS
Before angiographic embolization, color Doppler ultrasound identified five CSCs in 3/12 patients. One CSC was proximal to the fistula, and 4/5 were distal. After angiographic embolization, the fistula was not completely closed in these patients, fed by the distal CSCs. However, spontaneous closure occurred within 1 month. The fistula was also fed by CSCs in another two patients in whom these vessels were not evident before embolization. In one case, the fistula closed spontaneously within 1 week, while in the other case the fistula remained patent, fed by other collateral vessels.


CONCLUSIONS
The type of vessels that are involved in refilling the fistula after embolization is of concern for the outcome of the patients. In our series, the fistulas supplied only by CSCs closed spontaneously within 1 month. Watchful waiting should be preferred to repeated embolization to avoid the risk of unnecessary procedures.
Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy.
M
M
Bertolotto
R
R
Zappetti
R
R
Pizzolato
G
G
Liguori
D000293:Adolescent; D000328:Adult; D000792:Angiography; D001783:Blood Flow Velocity; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D008297:Male; D010413:Penis / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000293:injuries; D011142:Polyvinyl Alcohol / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011317:Priapism / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D016157:Vascular Fistula / Q000175:diagnosis* / Q000209:etiology
D011142:Polyvinyl Alcohol