Abstract
High flow priapism is mainly caused by traumatic arteriocavernous fistulas. The standard therapy is a transcatheter embolization of the fistula. This study analyzes the combined approach of arteriography and color Doppler ultrasound during the embolization procedure. During the arteriography procedure, a perineal color Doppler ultrasound examination of the fistula was performed to achieve an optimal positioning of the catheter tip in the fistula with a minimum of radiation exposure. To visualize the correct localization, ultrasound contrast medium or saline solution was injected through the catheter. The flow-pattern of the contrast medium allowed evaluation of the successful occlusion of the fistula and preservation of the unaffected penile arteries. In six patients (unilateral fistula: three, bilateral fistulas: three) with a posttraumatic high-flow priapism, this technique was performed for embolization of the fistulas. A total of nine embolization sessions were performed. Only one case required a second session due to dislocation of a microcoil. In all cases, the priapism disappeared immediately after the final session while erectile function was restored within 4 weeks after embolization. The combined approach of x-ray and ultrasound imaging facilitates the supraselective embolization of the arteriocavernous fistula, leading to an optimal success rate, while reducing the radiation exposure and the applied dose of contrast medium.
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References
Burt FB, Schirmer HK, Scott WW (1960) A new concept in the management of priapism. J Urol 83:60–63
Goerich J, Ermis C, Kraemer SC et al. (2002) Interventional treatment of traumatic priapism. J Endovasc Ther 9:614–617
Hakim LS, Kulaksizoglu H, Mulligan R et al. (1996) Evolving concepts in the diagnosis and treatment of arterial high flow priapism. J Urol 155:541–548
Hauri D, Spycher M, Bruehlmann W (1983) Erection and priapism: a new physiopathological concept. Urol Int 38:138–145
Kuefer R, Bartsch GJr, Herkommer K et al. (2004) Changing diagnostic and therapeutic concepts in high-flow priapism. Int J Impot Res (in press)
Miller ST, Rao SP, Dunn EK et al. (1995) Priapism in children with sickle cell disease. J Urol 154:844–847
Sancak T, Conkbayir I (2001) Post-traumatic high-flow priapism: management by superselective transcatheter autologous clot embolization and duplex sonography-guided compression. J Clin Ultrasound 29:349–353
Volkmer BG, Nesslauer T, Kuefer R et al. (2002) High-flow priapism: a combined interventional approach with angiography and colour Doppler. Ultrasound Med Biol 28:165–169
Volkmer BG, Nesslauer T, Kraemer SC et al. (2001) Prepubertal high-flow priapism: incidence, diagnosis and treatment. J Urol 166:1018–1022
Wear JBJr, Crummy AB, Munson BO (1977) A new approach to the treatment of priapism. J Urol 117:252–254
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Bartsch, G., Kuefer, R., Engel, O. et al. High-flow priapism: colour-Doppler ultrasound-guided supraselective embolization therapy. World J Urol 22, 368–370 (2004). https://doi.org/10.1007/s00345-004-0426-8
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DOI: https://doi.org/10.1007/s00345-004-0426-8