Diagnosis and X-ray endovascular methods of treatment of arterial priapism in children

Abstract

Introduction. Priapism is a pathological hemodynamic condition characterized by a prolonged erection unrelated to sexual stimulation that lasts more than four hours. There are arterial (non-ischemic, high-flow) and venous (venoocclusive, low-flow) priapisms, which differ in etiology, pathogenesis, and clinical manifestations. The formation of arterial high-flow priapism occurs due to trauma to the internal arteries of the penis and the formation of a pathological fistula between the arterial vessel and the sinusoidal tissue.Purpose of the study. To evaluate the efficacy and safety of X-ray endovascular technologies in the treatment of high-flow arterial priapism in children.Materials and methods. For the period from 2016 to 2020, 3 patients with high-flow post-traumatic arterial priapism were treated at the Pediatric Urology Clinic of St. Petersburg State Pediatric Medical University. On the first day after injury, all patients complained of dysuria, paresthesia, and pain in the penis. The development of a painless permanent erection, which persisted at the time of hospitalization, was formed no earlier than 2 days after the injury. Ultrasound with duplex mapping was used as a diagnostic method. In all patients, ultrasound and Doppler examination revealed an arteriosinusoidal fistula at the base of the cavernous bodies, with a highly active blood flow from the damaged branch of the deep artery of the cavernous body. All patients underwent superselective angiography of the vessels of the penis, followed by X-ray endovascular embolization of the arteriocavernous fistula.Results. In one case, an arterial autohemoclot with a contrast agent was used as a material for embolization. In two other cases, a suspension of a finely dispersed hemostatic sponge in a contrast agent was immediately applied. A recurrence of priapism was noted in a child after the application of an autohemoclot, after 12 days a repeated X-ray surgery was performed, a suspension of a hemostatic sponge was used as an embolization material. There were no surgical complications in the postoperative period. There were no complaints at the time of discharge. When viewed after 7, 14, 30 days, 6 months and one year, erectile dysfunction was not recorded.Conclusion. X-ray endovascular embolization of an arteriocavernous fistula is the method of choice in the treatment of patients with arterial high-flow post-traumatic priapism.