Successful Management of Recurrent High Flow Priapism Treated with Selective Arterial Embolization: A Case Report

Introduction: High-flow priapism is rare, uncontrolled arterial inflow, preceded by penile or perineal trauma and arterial-lacunar fistula. There are several ways to treat high-flow priapism,, i.e., conservative management, use of ice packs, mechanical decompression, surgery, and super-selective arterial embolization. Embolization is currently widely accepted in patients who fail from conservative management. This study aimed to report using gel foam and microcoil embolization in high-flow priapism recurrent to PVA embolization. Case Study: A 36-year-old man complained of prolonged erection. The erection occurred three days before admission while waking up in the morning, not accompanied by either sexual stimulation or pain. There was a history of fall four days ago in the afternoon, with the patients groin hitting a rocky ground. Physical examination revealed an erect penis which felt warm, with an EHS of 4. Blood gas analysis of the corpus cavernosum showed bright red blood with pH of 7.47, pCO2 23.6, pO2 145, HCO3 17.3, BE -6, and SaO2 99%. Doppler ultrasound examination of the penis showed high-flow priapism. Embolization with PVA was performed and there were decreased complaints. A few hours later erection occurred. Reevaluation was then performed and continued with embolization using gelfoam and microcoil. There were immediate successful results (EHS 3) accompanied by a decrease in symptoms. Long-term follow-up has shown a return to normal erectile function six months following the injury. Conclusion : Priapism may happen from various etiologies. Differentiating high-flow and low-flow is paramount during the acute phase because of different treatment strategies. Conservative management may be applied to high-flow priapism. If conservative management fails, embolization may be attempted. The choice of embolization agent must be taken into account.