High-flow post-traumatic priapism with delayed presentation

Priapism is an urgent urological condition with varied aetiology that may be classified as low flow (ischaemic) or high flow (non-ischaemic). Diagnosis requires detailed clinical history and examination combined with appropriate investigations such as cavernosal blood gas sampling and penile Doppler ultrasound. In the case of high-flow priapism CT angiography can identify sources of abnormal arterial blood flow and cases may be managed conservatively, with surgery or through arterial embolisation. We detail a case of a young man presented 2 weeks after perineal trauma with high-flow priapism with an equivocal penile Doppler ultrasound. Cavernosal blood gas sampling was consistent with arterial blood and CT angiography was performed showing an arteriovenous fistula. The patient was then successfully managed with arterial embolisation resulting in detumescence and preserving sexual function.