Post-traumatic penile pseudoaneurysm causing high-flow priapism: treatment with super-selective micro-coil embolisation after non-successful thrombin injection

Abstract

Introduction and Aim: Treatment of high-flow priapism varies from watchful waiting to mechanical compression with ice packs, aspiration, intracavernous admission of alpha- adrenergic agonists or even open surgery with ligation of the artery concerned. Embolisation is also a choise for treatment for high-flow priapism. Autologous clot, gelfoam, N-butyl-cyanoacrylate, and metallic micro-coils have been used as embolic agents. Case: In our case, we first used thrombin for autologous cloth formation but recanalisation occured. After two weeks we had to make superselective coil embolisation to bubocavernosal segment of pudental artery. Conclusion:Micro-coil embolisation was the permanent choise of treatment for post traumatic priapism.

Keywords

• Penil anevrizma
• Koil embolizasyonu
• Post-traumatic penile

Yüksek akımlı priapizm nedeni olan post-travmatik penil pseudoanevrizmanın başarılı olmayan trombin enjeksiyonu sonrası süper seçici mikro-coil embolizasyonu ile tedavisi

Abstract

Yüksek akımlı priapizm tedavisi buz uygulaması, aspirasyon, intrakavernöz alfa adrenerjik agonist ilaç enjeksiyonu ve kavernozal arterin açık cerrahi ile bağlanması ile de yapılabilmektedir. Embolizasyon da yüksek akımlı priapizm tedavisi için bir seçenek olabilir. Otolog pıhtı, gelfoam, N-bütil-siyanoakrilat ve metal mikro koiller embolizan materyal olarak kullanılmaktadır.Bizim vakamızda, ilk seçenek olarak otolog pıhtı oluşumu için trombin kullanılmıştı. Ancak rekanalizasyon oluşumu nedeniyle iki hafta sonra pudental arterin dalı olan bubocavernosal artere süperselektif coil embolizasyonu yapmak zorunda kaldık.Travmatik priapizm tedavisinde, mikro-coil embolizasyonu kalıcı tedavi seçeneği olmuştur

Keywords

• Penile aneurysm
• Coil embolisationartery is uncommon but a recognized condition as the patient presents with high flow priapism

References

1. Montague DK, Jarow J, Broderick GA et al. American Urological Association guideline on the management of priapism. J Urol 2003;170:1318–1324.
2. Papadopoulos I, Kelami A. Priapus and priapism: from mythology to medicine. Urology 1988;32:385-388.
3. Mourikis D, Chatziioannou AN, Konstantinidis P et al. Selective microcoil embolisation of a traumatic pseudoaneurysm of the cavernosal artery. Urol Int. 2000;64:220-222.
4. Liu KL, Liang PC, Tsang YM. Angiographic diagnosis of high flow priapism with superselective transcatheter embolisation and hematofibrinolytic therapy. Chin J Radiol 2001;26:169-172.
5. Langenhuijsen JF, Reisman Y, Reekers JA et al. Highly selective embolisation of bilateral cavernous arteries for posttraumatic penile arterial priapism. Int J Impot Res 2001;13:354-356.
6. Colombo F, Lovaria A, Saccheri S et al. Arterial embolisation in the treatment of post-traumatic priapism. Ann Urol 1999;33:210-213.
7. Gujral S, MacDonagh RP, Cavanagh PM. Bilateral superselective arterial micro-coil embolisation in delayed post-traumatic high-flow priapism. Postgrad Med J 2001;77:193-197.
8. Imamoglu A, Bakirtas H, Conkbayir I et al. An alternative noninvasive approach for the treatment of high-flow priapism in a child: Doppler ultrasound-guided compression. J Pediatr Surg 2006;41:446–448.

9. Spycher MA, Hauri D. The ultrastructure of the erectile tissue in priapism. J Urol 1986;135:142–147.
10. Dillman JR, Cho KJ. High-flow priapism after perineal trauma. Pediatr Radiol 2010;40:1299-1303.
11. Stock KW, Jacob AL, Kummer M et al. High-flow priapism in a child: Treatment with superselective embolisation. AJR Am J Roentgenol 1996;166:290–292.
12. Witt MA, Goldstein I, Saenz de Tejada I et al. Traumatic laceration of intracavernosal arteries: The pathophysiology of nonischemic, high flow, arterial priapism. J Urol 1990;143:129–132.
13. Bastuba MD, Saenz de Tejada I, Dinlenc CZ et al. Arterial priapism: Diagnosis, treatment and longterm followup. J Urol 1994;151:1231–1237.
14. Wear JB Jr, Crummy AB, Munson BO. A new approach to the treatment of priapism. J Urol 1977;117:252-255.