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Vascular and Interventional Radiology

E1090. Approach to Endovascular Management of High-Flow Priapism

Abdel Aal A,  Oser R,  Saddekni S,  Moawad S,  Ertel N. University of Alabama at Birmingham , Birmingham, AL

Address correspondence to A. Abdel-Aal (akamel66@hotmail.com)

Background Information: Priapism is defined as a persistent erection that lasts for several hours or beyond, independent of ongoing sexual stimulation. Because priapism can have serious long-term consequences that include loss of sexual function, it requires prompt evaluation and management. There are essentially two types of priapism. The first is low-flow or ischemic priapism which accounts for the majority (95%) of cases. High-flow priapism or nonischemic priapism is often associated with trauma to the perineum. Although the initial management may be similar, high-flow priapism is often due to an underlying arteriovenous fistula or pseudoaneurysm and can be safely and reliably treated with embolization if conservative management fails. This exhibit reviews the diagnosis of high-flow priapism with a focus on ultrasound findings. Normal and abnormal penile arterial anatomy are reviewed. Finally, the techniques for arterial embolization used in the treatment of high-flow priapism are discussed, focusing on selection of embolic material. A review of relevant literature and outcomes are presented.

Educational Goals/Teaching Points: We review different types and causes of priapism, discuss the clinical presentation and imaging findings of high-flow priapism, outline the management options with focus on the endovascular embolization of high-flow priapism, evaluate different types of embolic materials used with the advantages and disadvantages of each, outline potential treatment complication, and review the outcomes of endovascular treatment.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: The presentation is supported with multiple cases from our institution. We present the causes as well as the clinical presentation and radiologic findings (color duplex, CT, and angiogram) of these cases. A discussion of the details of endovascular management technique and the outcomes are provided.

Conclusion: Color duplex ultrasound is instrumental in the diagnosis of high-flow priapism. Penile angiography with super-selective embolization is a safe and effective treatment for high-flow priapism and became the reference standard for treatment. Super-selective embolization also ensures a high level of preservation of premorbid erectile function.