Spontaneous resolution of delayed onset, posttraumatic high-flow priapism

Area of Science:

• Urology
• Vascular Surgery
• Emergency Medicine

Background:

• Priapism, particularly the high-flow, non-ischemic type, can be painless and may not prompt immediate medical attention.
• Management options for high-flow priapism range from conservative approaches to invasive procedures like embolization or surgery, each with potential risks including erectile dysfunction.

Observation:

• A 24-year-old male presented with a six-day history of priapism, occurring 10 days after a perineal injury.
• Doppler ultrasonography identified a pseudoaneurysm of the cavernosal artery as the likely cause.
• A subsequent pudendal artery angiogram showed no active leak.

Findings:

• The patient's priapism resolved spontaneously four days after the angiogram.
• Normal erectile function was preserved following the spontaneous resolution of priapism.

Implications:

• This case suggests that non-ischemic priapism secondary to pseudoaneurysm may resolve spontaneously, even after a prolonged duration.
• Conservative management and observation may be a viable initial approach for high-flow priapism due to pseudoaneurysm, potentially avoiding complications of intervention.
• Further research into the natural history and optimal management of traumatic pseudoaneurysm-induced priapism is warranted.