Angiographic Diagnosis of High-Flow Priapism with Superselective Transcatheter Embolization and Hematofibrinolytic Therapy

A 54-year-old healthy man had an accident about one month ago. He slipped and hit on a protruding object and injured his perineal area. His penis was persistent semi-tumescence for one week since this trauma. No improvement was noted even consulting with clinics. He visited our hospital with painless persistent erection. There were no dysuria or hematuria. The urinalysis, complete blood count, prothrombin time, partial thromboplastin time, liver function studies and chest x-ray were within normal limits. There was no other pertinent history. On physical examination, the indurative mass was palpable in the penoscrotal junction. A color Doppler sonography was performed and the velocity of arterial flow in the left corpus cavernosum was increased. High flow priapism was suspected and angiography (Fig. 1) was performed from the right femoral arterial approach with a 4-F Cobra catheter (Target Therapeutics, Los Angeles). After the tip of catheter placed at the left internal pudendal artery, the angiography revealed enlarged left internal pudendal artery with extravasation of contrast medium from the left cavernoseal artery. The tip of catheter was sent to the left penile artery, embolized with Gelfoam strips. The postTAE angiogram (Fig. 2) showed the left penile artery was completely embolized, sparing the scrotal branch. The right internal pudenal artery was also catheterized and no reperfusion from the transverse communicating root. After embolization, the patient was discharged and followed up at the out-patient department. The sustained erection was improved at least 50%, but it did not subside completely. A dose of 106 U of WORKSHOP