Posttraumatic Arterial Priapism Treated with Superselective Embolization: Our Clinical Experience and a Review of the Literature
To present 12 cases of arterial priapism treated by superselective embolization and propose our management algorithm for this condition.
Between February 2013 and May 2018, 12 cases of arterial priapism caused by blunt trauma were treated by superselective embolization. The mean age of patients was 36 years (25–47 years). All of the patients had normal sexual capability before priapism (IIEF-5 scores 24–25). All patients were treated with superselective embolization after more than 3 weeks of simple conservative treatment had failed. All cases but one used a gelatin sponge as embolic agent. A microcoil was added in one case in which the gelatin sponge failed to occlude the pseudoaneurysm. After superselective embolization, ice pack and “observation” treatments continued. The sexual capability of the patients was evaluated by IIEF-5 scores at 6 months and 12 months postoperatively.
The mean follow-up period was 27.2 months (13–48 months). Three patients achieved complete detumescence immediately. Nine cases needed 2–17 days to return to a flaccid nonpainful state. No patient underwent a second embolization. The time needed to improve erectile function was from 7 days to 4 months. There has been no recurrence. Eleven patients treated with gelatin sponge have normal erectile function, while one patient treated with additional microcoil embolization had mild erectile dysfunction.
Superselective embolization of the fistula is an effective option for arterial priapism. Absorbable agents should be used. Superselective arterial embolization should be considered after 3 weeks of conservative treatment. Patients should undergo another 3 weeks of “observation” treatment before repeated intervention.
KeywordsArterial priapism Embolization Erectile dysfunction Urology
We thank the participants of the study. We were greatly appreciative to receive good advice concerning superselective embolization from Dr. Xindong Fan (Radiology Department, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai).
The study was supported by a grant from the National Natural Science Foundation of China (No. 81600519), Shanghai Science and Technology Commission (No. 18411960500), Integrated Traditional Chinese and Western Medicine of Shanghai (ZHYY-ZXYJHZX-1-03), Program for Outstanding Medical Academic Leader. Clinical Research Program of 9th People’s Hospital and Shanghai Jiao Tong University School of Medicine (JYLJ005). The article processing charges were funded by the authors.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Wan and Yao conceived the study, participated in its design, performed the intervention, coordination and drafted the manuscript. Zheng, Guo, Liu, and Fu participated in the study design and conducted the outpatient service and the data acquisition. Wang and Xie made critical revisions to the manuscript regarding important intellectual content.
Xiang Wan, Hai-Jun Yao, Da-Chao Zheng, Chong Liu, Shi-Bo Fu, Jian-Hua Guo, Min-Kai Xie, and Zhong Wang have nothing to disclose.
Compliance with Ethics Guidelines
All procedures performed in studies involving human participants were in accordance with the Shanghai Ninth People’s Hospital affiliated to Shanghai Jiao Tong University School of Medicine ethics committee and with the 1964 Helsinki declaration. Informed consent was obtained from all individual participants included in the study.
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.