Post-traumatic high flow priapism percutaneously treated with transcatheter embolisation

The aim of this paper is to present our experience in the percutaneous management of high-flow priapism with transcatheter embolisation and gelfoam.

We present three clinical cases in which an acute trauma caused the development of high-flow priapism. After differing initial management, all cases underwent arteriography, followed by demonstration of the arterial-lacunar fistula and embolisation with gelfoam.

Near immediate detumescence after the procedure confirmed the success of embolisation, which was supported by clinical and instrumental follow-up.

In high-flow priapism, the best therapeutic solution remains transcatheter arterial embolisation, with ultra-selective catheterisation by microcatheter and embolisation of the pudendal artery only, which is responsible for the post-traumatic arterial-lacunar fistula. This manoeuvre is not always technically easy, and requires experience and remarkable dexterity. Technical failure is always possible owing to the spasm of a peripheral arteriole that cannot be resolved with papaverine, and to the possible rehabilitation by the downstream contralateral circulation. Furthermore, the apprehension of the operator carrying out the procedure in this anatomical context may make the immediate result seem satisfactory, even if it is not optimal. All these considerations stress the need for a rigorous clinical and instrumental follow-up to guide later diagnostic and therapeutic choices.