Chronic post-traumatic high-flow priapism treated with temporary gelatin sponge embolization
A 26-year-old man presented with a non-painful priapism in the urology ambulatory care unit. The patient reported having a permanent full erection for more than 3 months following a perineal trauma by falling from a ladder and hitting his pelvic floor on the window board. The physical examination 3 months after the trauma revealed stiff corpora cavernosa and a well-perfused corpus spongiosum. There was no visible or palpable perineal trauma. He had no history of sickle cell disease and denied any use of cocaine. The ability to perform sexual intercourse was not impaired. A penile color Doppler sonography was performed and demonstrated an arteriocorporal fistula with turbulent flow between the right cavernosal artery and the corpus cavernosum, conclusive for a high-flow priapism.\nThe patient was admitted to our hospital and a selective angiography was performed. The internal pudendal artery was catheterized bilaterally with a 4 F RIM Tempo4 open-ended catheter (Cordis, Miami, FL, USA) by a right transfemoral approach and a selective angiography was performed. The diagnostic angiography revealed the presence of a bilateral contrast leak from the cavernosal artery to the corpus cavernosum which was most prominent via the right cavernosal artery (Figs. and ). Thereafter a microcatheter (2.7 F; Microferrit; Cook, Bloomington, IN, USA) was placed into the cavernosal artery with its catheter tip positioned right into the leak to the corpus cavernosum (Fig. ). The fistula was then embolized with gelatin sponge. The gelatin sponge was prior to the procedure fragmented into small pieces with a scalpel and eluted in contrast media resulting in a viscous thick fluid. Approximately 2 mL of the gelatin contrast media elution was injected via the microcatheter until stasis of the leakage was obtained. A superselective embolization via the right cavernosal artery was performed. The ACF disappeared completely (Fig. ). The patient described a complete penile detumescence 48 h after the procedure.\nFollow-up consisted of a color Doppler sonography 6 weeks after embolization. No ACF was detectable. The cavernosal arteries and the corpora cavernosa were bilaterally intact and well perfused. The priapism resolved completely and the patient reported a normal erectile function (Fig. ).