Aims and objectives
Priapism,
a relatively uncommon disorder,
is a medical emergency.
Although not all forms of priapism require immediate intervention,
ischemic priapism is associated with progressive fibrosis of the cavernosal tissues and Thus,
all patients with priapism should erectile be evaluated emergently in order to intervene as early as possible in those patients with ischemic priapism.
The goal of the management of all patients with priapism is to achieve detumescence and preserve erectile function.
Unfortunately,
some of the treatments aimed at correcting priapism have the potential complication...
Methods and materials
ØExperience of5 patients with mean age of 16 yrs.
ØDiagnosis of non-ischemic High Flow Priapism ( HFP )
ØInitialdiagnosis with High resolution Ultrasound andColor-Doppler.
ØConfirmed by pudendal arteriography ( DSA ).
ØMost common cause –microvessel arterio-corporal fistula. ( ACF )
Ø5 patients:5 Male; 0 Female.
Ø Age range :14 yr to 42 yr ,
average 16 yr.
ØOut of these,
on DSA :- One case of bilateral ACF.
- Two unilateral ACF.
- Unilateral ACF with pseudoaneurysm in two.
Ø Embolization agent used:fine ground Gel-foam...
Results
ØMost common etiology : direct / indirect trauma.
ØAll primary diagnosis made on high resolutionultrasound and
color doppler.
Type of Fistula
Number of cases
Percentages (%)
Unilateral
2/5
40
Bilateral
1/5
20
Unilateral with pseudoaneurysm
2/5
40
ØTechnical success in all cases.
Ø1 case( 20 % )repeat embolization -due to recurrencewithin 7days.
ØErectile function was restored in mean of 6 weeks.
Ø1 patient reported slight decrease in the quality of erection.
ØNo recurrence or any complication in mean followup of 5years.
Conclusion
ØColour-flow doppler ultrasound is a wonderful modality to diagnose
nonischemic HFP.
ØSuper selective transcatheter embolization with temporary
embolizing agentis an effective relatively non-invasive therapy
for the treatment of HFP.
Ø“ We as Interventional Radiologists,
can not only help to diagnose
this rare emergency ,
but can also help to treat it by minimally
invasive techniques and achieve excellent results as discussed”
References
1.
Broderick GA.
Iatrogenic priapism.
Urol Clin North Am 1996; 23;111-126.
2.
Paulter S.
High flow priapism.
Urol Clin North Am 2001;28: 391-403.
3.
Kang BC,
Lee DY,
Byun JY,
Baek SY,
Lee SW,
Kim KW.
Post-traumatic arteria priapism: colour Doppler examination and superselective arterial embolization.
in Radiol 1998;53: 830-834.
4.
Lue TF,
Broderick G.
Evaluation and nonsurgical management of erectile dysfunction and priapism.
In: Walsh P,
Retik A,
Vaughan ED,
Wein A,
editors. Campbells text book of urology.
Vol II.
7th ed.
Philadelphia: WB...