High-flow priapism-management experience with microcoils: A case report

Priapism is defined as a state of prolonged erection of the penis, not related to sexual desire or stimulation. It can be classified as high-flow or low-flow depending on the status of the penile arterial blood flow. The more common type, low-flow priapism, is due to stasis and diminished blood efflux from the cavernous bodies; while the high-flow type reveals uncontrolled blood in-flow. Most cases of high-flow priapism are related to perineal trauma, such as a straddle-type injury, in which the corporal artery is compressed against the pubic bone [1]. We report an adult patient with high-flow priapism due to combination of arteriocavernous fistula and pseudoaneurysm after perineal trauma. The patient was initially treated by bilateral superselective microcoils embolizations. Detumescence was achieved within one hour. Unfortunately, a recurrent pseudoaneurysm was present during follow-up examination. Second embolization with blood clots and Gelfoam pledgets was hence performed. The recurrent pseudoaneurysm remained identified after the second embolization; however, decreased in size. The patient had no any discomfort such as recurrent priapism with the existence of the smaller pseudoaneurysm and he regained normal morning erection and normal sexual function two months after the first embolization.