Post traumatic high-flow arterial priapism. The need for increased awareness among health care professionals

Abstract

High flow arterial priapism is a rare urological emergency. Presentation, diagnosis and institution of definitive management are often delayed. We describe our experience with this diagnostic entity and reviewed the literature to define possible reasons for the delayed diagnosis and management. We report two patients (10 years and 35 years old) that presented following blunt perineal trauma. The presentation and diagnosis of arterial priapism were delayed in both patients. Selective angiogram of the internal pudendal artery revealed arteriocavernous fistula in each patient. Embolization of the fistulae by gel foam was carried out at the same sitting. Penile detumescence was noted in both patients at the conclusion of the angiographic embolization. Both patients regained erectile function 3 and 6 weeks post treatment. Awareness of the various etiologic factors in priapism is of paramount importance to establish the correct diagnosis and institute the appropriate treatment modalities. Absence of pain and preservation of potency in patients with arterial priapism are among factors that contribute to the delayed presentation, diagnosis and treatment. We reiterate the valuable role for selective internal pudendal artery angiography as a single investigation that provides both diagnostic and therapeutic means of management.