Introduction

High-flow priapism is characterised by a prolonged non-painful erection secondary to the formation of an arterial-lacunar fistula usually following perineal blunt trauma. This leads to high arterial blood flow into the lacunar spaces, as the high-resistance helicine arteries are bypassed. The condition is therefore not considered an emergency as blood remains oxygenated and cellular damage is not expected. Current management includes conservative measures or angioembolisation of the cavernosal artery. The aim of this study is to review the real life outcomes of a large group of men referred to a tertiary specialist centre following a diagnosis of HFP.

Methods

Twenty-three patients were identified from a prospective database between 2008 and 2016. Diagnosis was based on blood-gas analysis, clinical and radiological findings. Patients were managed either conservatively (n=3) or with super selective angioembolisation of the cavernosal artery (n=20). Outcome measures studied were resolution of priapism, number of embolisations and development of long-term erectile dysfunction.

Results

All patients had high flow priapism confirmed on colour penile Doppler studies. Trauma was the causative factor in 83% of cases. In 15 patients (88%) 2 or less embolisations were necessary to achieve persistent detumescence. Erectile dysfunction was reported in 89% of patients at last follow-up. Recovery of erectile function over time occurred in 11%. An MRI scan of the penis was performed in 8 patients and showed the presence of corporal fibrosis in all cases; a further 2 had corporal fibrosis demonstrated on ultrasonographic imaging. 50% managed conservatively developed corporal fibrosis on imaging (vs. 40% embolised).

Conclusions

Our data suggests that angioembolisation has a high success rate in producing detumescence but also that, if not promptly treated, high flow priapism leads to corporal fibrosis and ultimately erectile dysfunction. Therefore a conservative approach should be discouraged and patients should proceed to early angioembolisation._x000D_ _x000D_

Funding

none