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Case Reports in Urology
Volume 2019, Article ID 3916056, 4 pages
https://doi.org/10.1155/2019/3916056
Case Report

Superselective Embolization with Microcoil and Gelfoam for High-Flow Priapism Secondary to Bilateral Cavernous Fistulae: A Case Study

University Hospital Southampton, Tremona Road, Southampton, Hampshire SO166YD, UK

Correspondence should be addressed to Sarah Prattley; ten.shn@yelttarp.haras

Received 27 January 2019; Accepted 3 April 2019; Published 16 April 2019

Academic Editor: Khaled Madbouly

Copyright © 2019 Sarah Prattley et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. High-flow priapism is rare, and bilateral arteriocavernous fistulae formation following trauma is rarer still. Management of high-flow priapism is conservative either through observation, use of ice packs, mechanical decompression, or intracavernosal injection of α-adrenergic agonists, giving temporary results in selected cases. Alternatively, superselective arteriography with embolization is widely accepted. However, intervention needs to be mindful of the potential impact on long-term potency. We report the first case of bilateral arteriocavernous fistulae managed with both Gelfoam and microcoil embolization. Case Study. We present the case of a 35-year-old gentleman who attended the emergency department nine days following a fall from a moped, where he sustained bruising to his perineum, with persistent nonpainful erection. CT angiogram demonstrated bilateral arteriovenous fistulas. Management with superselective catheterisation and embolization with Gelfoam and microcoil was successful with resolution of symptoms. Long-term follow-up has shown return to normal erectile function twelve months following the injury. Outcomes. Concern regarding the effect to long-term erectile function has previously led to delayed bilateral embolization. Selection of embolization material can be tailored to the anatomical features of the fistula to help preserve function.