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High-flow priapism in a 12-year-old boy: Treatment with superselective embolization.
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MedLine Citation:
PMID:  19955685     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Priapism is caused by an imbalance between penile blood inflow and outflow. There are two types of priapism: low-flow priapism due to venous occlusion and high-flow priapism due to uncontrolled arterial flow to the veins. High-flow priapism most frequently occurs as a result of penile trauma in which the intercavernosal artery disruption causes an arteriocavernosal fistula. It is rarely encountered in the pediatric and prepubertal population. Clinically, it manifests as a painless, prolonged erection after perineal trauma. Treatment ranges from expectant management to open surgical exploration with vessel ligation. We report the successful treatment of high-flow priapism in a 12-year-old prepubertal boy with superselective embolization.
Authors:
A R Mossadeq; R Sasikumar; M Z M Nazli; A M Shafie; M D M Ashraf
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Indian journal of urology : IJU : journal of the Urological Society of India     Volume:  25     ISSN:  1998-3824     ISO Abbreviation:  Indian J Urol     Publication Date:    2009 Oct-Dec
Date Detail:
Created Date:  2009-12-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8510441     Medline TA:  Indian J Urol     Country:  India    
Other Details:
Languages:  eng     Pagination:  539-40     Citation Subset:  -    
Affiliation:
Urology Unit, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150-Kubang Kerian, Malaysia, .
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Full Text
Journal Information
Journal ID (nlm-ta): Indian J Urol
Journal ID (publisher-id): IJU
ISSN: 0970-1591
ISSN: 1998-3824
Publisher: Medknow Publications, India
Article Information
? Indian Journal of Urology
open-access:
Print publication date: Season: Oct?Dec Year: 2009
Volume: 25 Issue: 4
First Page: 539 Last Page: 540
ID: 2808664
Publisher Id: IJU-25-539
PubMed Id: 19955685
DOI: 10.4103/0970-1591.57918

High-flow priapism in a 12-year-old boy: Treatment with superselective embolization
A. R. MossadeqAF0001
R. SasikumarAF0001
M. Z. M. NazliAF0001
A. M. Shafie1
M. D. M AshrafAF0001
Urology Unit, Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150-Kubang Kerian, Malaysia
1Radiology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150-Kubang Kerian, Malaysia
Correspondence: For correspondence: Dr. Mossadeq Abdul Razack, 60, Viswashanthi Nagar Post & Telegraph Nagar, Madurai-625017, India. E-mail: drmossadeq@yahoo.co.in

CASE REPORT

A 12-year-old boy was referred to Hospital Universiti Sains Malaysia from a district hospital one week following perineal trauma with painless priapism for five days. On examination, his corpus cavernosa was rigid and his glans and corpus spongiosum was soft and compressible [Figure 1]. He was voiding normally and all medical illnesses were ruled out. Bright red blood was withdrawn from the cavernosum and blood gas analysis confirmed arterial blood, suggesting the diagnosis of high-flow priapism. Doppler ultrasonography confirmed the diagnosis and showed an arteriovenous fistula on the left side at the base of penis.

He was treated with selective left internal iliac artery and left internal pudendal artery angiography and superselective cannulation and embolization of the left cavernosal artery. Total occlusion of the arteriovenous fistula and normal blood flow was seen thereafter. Clinically, complete detumescence of the penis occurred [Figure 2]. He was observed in ward for 24 hours and discharged home the next day.


DISCUSSION

High-flow priapism is usually due to a traumatic arteriocavernosal fistula and causes a nonischemic, painless engorgement of the corpora cavernosa. In high-flow priapism, the fistula bypasses the helicine artery, and the arterial blood flows into the sinusoidal space. Penile erection is caused by an excess of arterial inflow followed by a stretching of the corporal sinuses. Diagnosis can be confirmed by duplex sonography, cavernosal blood gas determination or angiography. Duplex sonography can show the presence and site of the fistula and should be performed initially because of the noninvasiveness. Findings in cases of high-flow priapism include focal brush of pulsatile, turbulent flow with elevated flow velocities adjacent to cavernous artery.[1] A few patients of prepubertal age with high-flow priapism treated by selective embolization have been described.[2] Angiography with subsequent superselective embolization can now be considered as the treatment of choice for high-flow priapism. This procedure effectively corrects the arterial overflow and normally preserves potency with encouraging long-term results.[3]


CONCLUSION

We report the successful treatment of high-flow priapism in a 12-year-old prepubertal boy with superselective embolization. A rare entity successfully managed by the urology and radiology team at Hospital Universiti Sains Malaysia.


Notes

Source of Support: Nil

Conflict of Interest: None declared.

REFERENCES
1. Feldstein VA. Posttraumatic high-flow priapism evaluation with color flow Doppler sonographyJ Ultrasound MedYear: 199312589938246338
2. Dewan PA,Lorenz C,Davies AR. Posttraumatic priapism in a 7-year-oldboyEur UrolYear: 1994258578307084
3. Miller SF,Chait PG,Burrows PE,Steckler RE,Khoury AE,McLorie GA,et al. Posttraumatic arterial priapism in children: management with embolizationRadiologyYear: 199519659627784590

Figures

[Figure ID: F0001]
Figure 1 

Penis in erected state with perineal trauma



[Figure ID: F0002]
Figure 2 

Penis assuming flaccid state following super-selective embolization of the fistulous site



Article Categories:
  • Case Report

Keywords: High-flow priapism, perineal trauma, super selective embolization.

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