Postsurgical high flow priapism treated by transarterial embolizaton: a case report

Area of Science:

• Urology
• Vascular Surgery
• Radiology

Background:

• Iatrogenic arterial injury can lead to rare complications like priapism.
• Endoscopic internal urethrotomy for urethral strictures carries a risk of vascular damage.
• Understanding the vascular anatomy is crucial for managing such complications.

Observation:

• A patient presented with painful priapism following endoscopic internal urethrotomy.
• Physical examination revealed sustained erection, penile swelling, and perineal tenderness.
• Angiography identified an arterio-sinusoidal fistula involving the internal pudendal and deep penile arteries.

Findings:

• Superselective arterial embolization using Gelfoam was performed in a single session.
• The procedure successfully occluded the arterio-sinusoidal fistula.
• Initial erectile dysfunction persisted for six months post-embolization.

Implications:

• Arterial embolization is an effective treatment for iatrogenic arterio-sinusoidal fistulas causing priapism.
• Delayed recovery of erectile function is possible after successful fistula treatment.
• This case highlights the importance of recognizing and managing vascular complications after urological procedures.