Successful Management of Post-traumatic High-Flow Priapism by Super-Selective Coil Embolization: A Case Report

Abstract

Priapism is a rare andrological emergency characterized by a prolonged penile erection that is not provoked by sexual excitation or stimulation and lasts longer than 4 hours. There are three different types of this emergency that can be encountered in clinical practice based on the episode history and pathophysiology, including veno-occlusive (ischemic or low-flow priapism), arterial (non-ischemic or high-flow priapism), and stuttering priapism. High-flow priapism is the less common type, which accounts for approximately 5%–10% of cases. This type is caused mainly by trauma to the penis, perineum, or a pelvis fracture that may lead to an arterio-cavernous fistula or pseudoaneurysm with a subsequent uncontrolled arterial inflow to the penis. This type of emergency is under-reported, and a low number of cases have been documented. Therefore, the effectiveness, encountered risks, as well as management outcomes are still limited. Hereby, we report a case of a 29-year-old male who presented to the emergency department complaining of a persistent painless penile erection for 2 weeks following perineal trauma (falling astride). A multidisciplinary clinical evaluation and management by a selective embolization technique are discussed in this case report.

Keywords

• high flow
• non-ischemic
• post-traumatic
• priapism
• selective embolization