Liu Shiyi, Deng Jiangbei, Zeng Bin, Jia Yiping
Department of Interventional Radiology, Affiliated Changsha Central Hospital, University of South China, Changsha.
Department of Interventional Radiology of Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Medicine (Baltimore). 2019 Jul;98(27):e16184. doi: 10.1097/MD.0000000000016184.
Microcoils are a permanent embolic material, and blood vessels that have been embolized by a microcoil remain occluded for a prolonged period of time. The pudendal artery is an important functional vessel for penile erection. Whether simultaneous embolization of the bilateral pudendal artery using microcoils can seriously affect penile erection has not been sufficiently studied.
A 47-year-old male patient, after undergoing brain surgery, accidentally pulled out the Foley catheter causing a urethral hemorrhage. The patient was immediately treated using a new larger Foley catheter inserted under urethroscopic guidance and medication. However, massive bleeding occurred on the tenth day after the procedure.
A right internal iliac angiography performed after the bleeding event demonstrated a rupture at the end of the right internal pudendal artery with the contrast agent flowing out directly from the urethra. A super selective internal pudendal angiogram showed a small amount of hemorrhage at the end of the left internal pudendal artery.
The patient underwent interventional treatment. After the bilateral internal iliac angiography was performed, super-selective internal pudendal artery embolization with microcoils was performed. A subsequent bilateral internal pudendal angiogram did not show any abnormality.
During the follow up period of 2 months, the patient had no complaints of difficulty in urination or sexual dysfunction.
Some doctors do not advocate the use of coils as embolic agents in bilateral pudendal artery lesions because of concerns over erectile dysfunction. There is rich vascular circulation in the perineum. Thus, in arterial embolization for the treatment of penile bleeding, regardless of the type of embolic material used, the key is to ensure accurate embolization to maintain good collateral circulation. This principle can help limit the occurrence of sexual dysfunction to the lowest possible levels after such procedures.
微线圈是一种永久性栓塞材料，被微线圈栓塞的血管会长期保持闭塞状态。阴部动脉是阴茎勃起的重要功能血管。使用微线圈同时栓塞双侧阴部动脉是否会严重影响阴茎勃起尚未得到充分研究。
一名47岁男性患者，在接受脑部手术后，意外拔出导尿管导致尿道出血。患者立即在尿道镜引导下插入新的更大号导尿管并用药治疗。然而，术后第10天出现大量出血。
出血事件后进行的右侧髂内动脉血管造影显示右侧阴部内动脉末端破裂，造影剂直接从尿道流出。超选择性阴部内动脉造影显示左侧阴部内动脉末端有少量出血。
患者接受了介入治疗。在进行双侧髂内动脉血管造影后，用微线圈对阴部内动脉进行超选择性栓塞。随后的双侧阴部内动脉造影未显示任何异常。
在2个月的随访期内，患者无排尿困难或性功能障碍的主诉。
一些医生因担心勃起功能障碍而不主张在双侧阴部动脉病变中使用线圈作为栓塞剂。会阴部有丰富的血管循环。因此，在动脉栓塞治疗阴茎出血时，无论使用何种栓塞材料，关键是要确保准确栓塞以维持良好的侧支循环。这一原则有助于将此类手术后性功能障碍的发生率降至最低水平。
