Arrichiello Antonio, Angileri Salvatore Alessio, Buccimazza Giorgio, Di Bartolomeo Francesco, Di Meglio Letizia, Liguori Alessandro, Gurgitano Martina, Ierardi Anna Maria, Papa Maurizio, Paolucci Aldo, Carrafiello Gianpaolo
Postgraduation School in Radiodiagnostics, Univeristà Degli Studi di Milano, Milan, Italy.
Operative Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy.
Acta Biomed. 2020 Sep 23;91(10-S):e2020010. doi: 10.23750/abm.v91i10-S.10233.
High-flow priapism is a persistent partial penile tumescence, related to high flow arterial blood into the corpora. In the treatment of high flow priapism, super-selective embolization is considered treatment of choice when conservative treatment fails as reported in the "EAU Guidelines on Priapism", but there are only few series reporting the outcome, the efficacy of different embolic materials and these studies are uncontrolled and relatively small.
The aim of this study is to review the literature to outline the state of the art of this interventional treatment and to analyse the outcome of the different embolic agents.
Through Medline database we searched all the English-language published articles related to priapism. Keywords were chosen according to MeSH terms. We selected case-series from 1990 to 2020 including at least five cases of high-flow priapism.The variables extracted from the selected articles were: number of patients, mean age, diagnostic imaging modality, mono or bilateral involvement of the arteries, embolization material, technical success, clinical success, complications, recurrence rate and type of reintervention, mean follow up, onset of erectile dysfunction.
We analyzed 11 papers.A total of 117 patients, mean age of 30 years, were studied during a period of 8 to 72 months. Technical success average was 99%, varying from 93 to 100%. Clinical success average was 88%, varying from 56 to 100%. After two or more treatments, resolution of priapism was obtained in all patients. No major adverse events registered. Recurrence rate of 21%(25/117) was observed, and only 4 pts underwent surgery. A total of 17 pts (15%) developed erectile dysfunction (ED).
Our data suggested comparable outcomes using different types of materials.In line with the last evidences we suggest that the choice of the embolic material should be selected basing on the expertise of the operator, the characteristic of the fistula and characteristic of the patients.
高流量性阴茎异常勃起是阴茎持续部分肿胀，与流入海绵体的高流量动脉血有关。如《欧洲泌尿外科学会阴茎异常勃起指南》所述，在高流量性阴茎异常勃起的治疗中，当保守治疗失败时，超选择性栓塞被认为是首选治疗方法，但仅有少数系列报道了治疗结果、不同栓塞材料的疗效，且这些研究缺乏对照且规模相对较小。
本研究旨在回顾文献，概述这种介入治疗的现状，并分析不同栓塞剂的治疗结果。
通过Medline数据库，我们检索了所有与阴茎异常勃起相关的英文发表文章。关键词根据医学主题词表选择。我们选择了1990年至2020年的病例系列，包括至少5例高流量性阴茎异常勃起病例。从所选文章中提取的变量包括：患者数量、平均年龄、诊断成像方式、动脉单侧或双侧受累情况、栓塞材料、技术成功率、临床成功率、并发症、复发率及再次干预类型、平均随访时间、勃起功能障碍的发生情况。
我们分析了11篇论文。在8至72个月的时间里，共研究了117例患者，平均年龄30岁。技术成功率平均为99%，范围从93%至100%。临床成功率平均为88%，范围从56%至100%。经过两次或更多次治疗后，所有患者的阴茎异常勃起均得到缓解。未记录到重大不良事件。观察到复发率为21%（25/117），仅有4例患者接受了手术。共有17例患者（15%）出现了勃起功能障碍（ED）。
我们的数据表明，使用不同类型的材料治疗结果相当。根据最新证据，我们建议应根据操作者的专业知识、瘘管的特征和患者的特征来选择栓塞材料。
