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Post-traumatic arterial priapism in the child: a study of four cases
J Moscovici1, E Barret, P Galinier
1Paediatric Surgery Department, Purpan Hospital, Toulouse, France.
Insights
Arterial priapism in children, a rare condition, often resolves spontaneously within three weeks. Observation alone may be the initial management strategy for this penile injury complication.
Area of Science:
- Pediatric Urology
- Vascular Surgery
Background:
- Arterial priapism is a rare condition in children, characterized by high-flow priapism resulting from penile or perineal injury.
- It involves damage to a cavernosal artery, leading to an arteriosinusoidal fistula, with onset typically occurring days after the injury.
Observation:
- The condition is usually painless, with reduced penile tumescence in the anterior third.
- Clinical presentation and injury context suggest the diagnosis.
- Doppler ultrasound is crucial for confirming and locating the fistula.
Findings:
- Four pediatric cases of arterial priapism are presented, a condition with only 13 prior literature reports.
- Spontaneous resolution occurred within three weeks in all reported cases, without recurrence or long-term erectile dysfunction.
- Traditional treatments like alphastimulant injections and surgery have limitations or risks.
Implications:
- Initial management may involve observation alone, reserving interventions like embolization for persistent cases.
- Further studies are needed to define the optimal observation period before intervention.
- Understanding spontaneous resolution patterns can guide conservative management approaches in pediatric arterial priapism.
Abstract:
The authors report four cases of arterial priapism in the child, a rare condition since only 13 cases are described in the literature. High-flow priapism follows perineal or penile injury with damage to a cavernosal artery and formation of an arteriosinusoidal fistula. The onset may be immediate but more often occurs after a few days. Arterial priapism is painless, as the corpora cavernosa are less tumescent in the anterior third of the penis. The clinical appearance and circumstances of onset suggest the diagnosis. Doppler ultrasound is the complementary investigation of choice, confirming and localising the fistula. Various methods of treatment have been proposed. Injections of alphastimulant seem ineffective in most cases and are not without danger. Surgery, which is potentially damaging, has been used only in the adult. Most authors propose embolising with resorbable material the artery which feeds the fistula. However, priapism may resolve spontaneously in less than three weeks, as occurred in our cases, without recurrence or subsequent erectile dysfunction. We thus consider the condition may initially be managed by observation alone, with recourse to embolisation if priapism does not resolve after a period of time which however remains to be defined.