High-flow priapism – the successful direct excision of arterio-lacunar fistula

High-flow priapism is a relatively rare pathology. Thus, there are not many large studies evaluating its management. The article describes the case of a patient with high-flow priapism caused by an arterio-lacunar fistula resulting from a perineal trauma affecting the base of the left cavernous body. After unsuccessful selective embolization open direct excision of the vascular malformation was performed. The localization of the lesion was enabled by clinical examination and by Doppler ultrasound. The treatment was successful and erectile function fully recovered after one month. This simple method may be of value when modern minimally invasive techniques appear to be uneffective. fig. 1. Partial almost painless erection with small induration at the base of the left cavernous body. fig. 2. Arterio-lacunar fistula with high flow visible in color Doppler study.