Embolization of the Internal Pudendal Arteries for High-Flow Priapism

Abstract

Low-flow priapism is due to the obstruction of the venous return, which can be of hematologic, iatrogenic origin or secondary to a spinal cord injury. It is painful and constitutes a urologic emergency, because it exposes the patient to cavernous ischemia. In comparison, high-flow priapism, which is linked to a prolonged, unregulated increase in the arterial flow, is a lot less frequent. It is not painful and does not evolve towards an ischemia and is generally secondary to a perineal or direct-penile trauma. Symptoms are often well tolerated (hence explaining the sometimes prolonged delay before reference); they include a non-painful penis that is not as rigid as in the venoocclusive priapisms, as well as signs of “perineal compression”: partial or total detumescence at perineal digital pressure. A puncture with washing out of the corpus cavernosum classically permitted to distinguish low-flow from high-flow priapisms with in the latter case bright red blood and arterial oxygen level; it is today only necessary when the diagnosis of high-flow priapism is dubious (absence of obvious traumatic etiology, painful erection, recurrence of symptoms, risk factors for a venoocclusive priapism). Duplex Doppler ultrasound can also confirm a high-flow priapism and sometimes permits the location of some fistulas.