Numan Furuzan, Cantasdemir Murat, Ozbayrak Mustafa, Sanli Oner, Kadioglu Ates, Hasanefendioglu Aylin, Bas Ahmet
Department of Radiology, Division of Interventional Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
J Sex Med. 2008 Jan;5(1):173-9. doi: 10.1111/j.1743-6109.2007.00560.x.
High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases.
To review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism.
Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism.
Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color-flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance.
The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection.
Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure.
高流量性动脉性阴茎异常勃起较为罕见，其特征为长时间无痛性勃起。自体血凝块栓塞术在大多数情况下可使该问题完全解决。
回顾我们在超选择性经导管栓塞术治疗非缺血性阴茎异常勃起方面的经验。
借助更新技术对非缺血性阴茎异常勃起的认识进展改变了当前对非缺血性阴茎异常勃起的治疗方法。
2002年至2006年间，11例因阴茎或会阴部钝性创伤导致非缺血性阴茎异常勃起的患者接受了超选择性经导管栓塞术。所有患者均接受了彩色多普勒超声和超选择性阴部动脉造影诊断评估，结果显示2例为双侧动脉海绵体瘘和假性动脉瘤，1例为双侧动脉海绵体瘘，1例为单侧动脉海绵体瘘，7例为单侧动脉海绵体瘘和假性动脉瘤。所有病例均在微导管引导下使用自体血凝块作为栓塞剂。
所有病例手术在技术上均获成功。3例（27.2%）因阴茎异常勃起复发需要再次栓塞。所有患者在术后6周内勃起功能均得以恢复。最后一次手术后6个月和12个月的随访显示，11例患者中有10例恢复了完全勃起能力，且这些患者未再出现阴茎异常勃起复发。1例患者报告其阴茎勃起质量略有下降。
我们的经验表明，超选择性经导管栓塞术及用自体血凝块短暂阻塞瘘管是治疗非缺血性阴茎异常勃起的有效方法。此外，闭塞血管再通导致勃起功能恢复发生在术后数周。
