Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2023; 11(1): 225-232
Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.225
High-flow priapism due to bilateral cavernous artery fistulas treated by unilateral embolization: A case report
Guo Li, Yi Liu, Hao-Yang Wang, Fei-Zhou Du, Zhi-Wei Zuo
Guo Li, Yi Liu, Fei-Zhou Du, Zhi-Wei Zuo, Department of Radiology, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Hao-Yang Wang, Department of Nuclear Medicine, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China
Author contributions: Li G and Zuo ZW contributed to manuscript writing and editing and data analysis; Liu Y contributed to provision of study materials; Wang HY contributed to data collection; Du FZ contributed to administrative support; all authors have read and approved the final manuscript.
Supported by Foundation of the General Hospital of Western Command, No. 2021-XZYG-C04.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Wei Zuo, PhD, Doctor, Department of Radiology, The General Hospital of Western Theater Command, No. 270 Rongdu Avenue, Jinniu District, Chengdu 610083, Sichuan Province, China. zuozhiwei@outlook.com
Received: October 17, 2022
Peer-review started: October 17, 2022
First decision: October 28, 2022
Revised: November 7, 2022
Accepted: December 9, 2022
Article in press: December 9, 2022
Published online: January 6, 2023
Processing time: 79 Days and 11 Hours
Abstract
BACKGROUND

High flow priapism (HFP) is a rare type of priapism. Perineal trauma is the most common cause of HFP. Trauma-induced penile artery injury may lead to an arterial-cavernosal fistula, whereas persistent irregular arterial blood flow entering the corpora cavernosum can cause a persistent penile erection. The routine treatment of HFP focuses on addressing the abnormal penile erectile status and avoiding post-treatment erectile dysfunction. Interventional embolization is an important therapeutic modality for HFP, and bilateral embolization therapy is currently the most commonly used technique for patients with bilateral cavernous artery fistulas; however, unilateral embolization therapy has yet to be reported.

CASE SUMMARY

Herein, we report of the case of a 26-year-old Chinese male who presented with a persistent abnormal erection for 12 h after perineal impact injury. Medical history, cavernous arterial blood gas analysis and radiological examinations led to a diagnosis of HFP caused by bilateral cavernous artery fistulas. We performed routine conservative treatment (compression therapy and ice application) for the patient after admission; however, 10 d later, his symptoms had not been relieved. After completion of the preoperative workup, right (severe side) selective perineal artery embolization was performed; the left cavernous artery fistula was left untreated. After postoperative continuation of conservative treatment for 72 h, the patient experienced complete penile thinning. The patient had no symptoms of erectile dysfunction over a follow-up period of 12 mo.

CONCLUSION

Compared with bilateral cavernous artery fistula embolization, we believe that unilateral cavernous artery fistula embolization can achieve positive clinical efficacy and reduce the risk of postoperative erectile dysfunction secondary to penile ischemia.

Keywords: High flow priapism; Elective pudendal artery embolization; Cavernous fistula; Erectile dysfunction; Case report

Core Tip: High flow priapism (HFP) is a rare type of priapism. Interventional embolization is the treatment of choice for HFP that is refractory to conservative management (compression therapy and ice application). In patients with HFP due to bilateral cavernous artery fistulas, the interventional treatment has primarily involved bilateral embolization. However, the treatment modality of bilateral embolization may increase the risk of erectile dysfunction because of postoperative ischemia. Compared with bilateral embolization, unilateral embolization may reduce the risk of erectile dysfunction while achieving clinical outcomes. This is the first report of successful HFP using unilateral embolization for bilateral cavernous artery fistulas.