Interventional radiology: Diagnosis and treatment of post-traumatic nonischemic priapism: A case report

Abstract

Priapism is defined as a form of erectile dysfunction characterized by a prolonged and involuntary penile erection, either partial or complete, occurring without sexual stimulation and lasting for more than 4 hours. Its incidence is estimated to be 0.5-0.9 cases per 100,000 people per year. The most frequent form is ischemic priapism, results from paralysis of the cavernous smooth muscles, which are unable to contract, leading to the stagnation of hypoxic blood within the sinusoidal spaces. Characterized by a painful rigid and sustainable erection. Non-ischemic priapism constitutes a rare entity, unlike the former, this type is typically painless. It is caused by an excessive influx of blood into the penis without a concomitant increase in outgoing blood flow. Blunt trauma is the most commonly reported etiology. And finally, recurrent priapism is characterized by recurrent episodes of prolonged erection and can be challenging to treat, often requiring long-term management to prevent recurrences. We report a case of high-flow priapism in a 10-year old child, secondary to a cavernous arterial fistula following a straddle injury during sports activity. It was suspected clinically and confirmed by ultrasound-Doppler, then successfully treated radiologically with highly selective embolization, with very satisfactory postoperative outcomes.

Keywords: Arterial embolization; Erectile function; Interventional radiology; Non-ischemic priapism; Penile trauma.

Fig. 1

Color ultrasound Doppler shows an abnormal increased color flow in focal zone of the left corpora cavernosa and adjacent soft tissues (black arrow) (A). (B) Dilated vascular lake with turbulent flow and high flow velocity characteristic of arteriovenous fistula with high peak systolic velocity, PSV = 9.3 cm/sec (red arrow).

Fig. 2

(A) Non-subtracted arteriography, (B) Subtracted arteriography performed from the anterior trunk of the left internal iliac artery, reveals contrast extravasation into the corpus cavernosum (blue arrow) through a breach in the left cavernous artery (yellow arrow), a terminal branch of the internal pudendal artery (red arrow). The integrity of the deep dorsal artery (black arrow) is maintained.

Fig. 3

Subtracted supra-selective arteriography: (A) left penile artery: opacification refluxing into the perineal artery (red arrow), demonstrating contrast extravasation into the corpus cavernosum (blue arrow) through a breach in the left cavernous artery (yellow arrow). (B) occlusion of the left cavernous artery and the deep dorsal artery using Spongel (green arrow). (C) Right internal iliac artery: demonstrating normal nonpathological opacification of the penile and perineal vasculature. Cavernous artery (white arrow), deep dorsal artery (gray arrow), perineal arteries (blue arrow).

Fig. 4

Ultrasound with Color Doppler control shows a permeabilization of the left cavernous artery (A and B) (blue arrow) and no recurrence of the fistula (C) (red arrow).