Purpose: We present 15 cases of high flow priapism treated by selective embolization and evaluate erectile function at long-term followup.
Materials and methods: Between 1995 and 2001, 15 patients underwent highly selective embolization of the cavernous artery for high flow priapism. Trauma was reported by 12 of the 15 patients, and no etiologic causes were evident in the other 3. The fistula was unilateral in 13 patients and bilateral in 2. All patients underwent embolization during arteriography. Erectile function was determined using the International Index of Erectile Function (IIEF) at followup after an average of 55 months (range 18 to 93).
Results: Postoperative color Doppler ultrasonography showed no recurrence in 11 patients (73%). Repeat pelvic angiography with selective embolization was required at 1 month postoperatively in 3 patients (20%). In 1 case (7%) 3 consecutive embolizations were not conclusive and a surgical operation was required. The IIEF results showed that sexual function was in the normal range in 80% of patients. Three patients (20%) reported a slight change in the quality of erection. Mean postoperative IIEF score was 26.3 (range 18 to 30).
Conclusions: Highly selective embolization of the fistula is an effective and safe treatment option for high flow priapism because it ensures a high level of preservation of pretreatment erectile function.