Microcoil embolization in post-traumatic high-flow priapism.

An 18-year-old male developed post-traumatic priapism subsequent to a fall causing blunt perineal trauma. Color Doppler ultrasound showed a high-flow arterio-venous fistula with feeders from branches of the left internal iliac artery. Selective arteriography of the left internal pudendal artery demonstrated an arterio-venous fistula. A curved-tip 2.3 French microcatheter (Terumo Medical Corporation, Tokyo, Japan) was advanced proximal to the fistula over a 0.014″ flexible guidewire. The fistula was then embolized with 2 platinum 18-2-2 Hilal Embolization Microcoils (Cook, Bloomington, Indiana). Improvement was noted, with closure of the fistula at check angiography and significant detumescence on table. This was later confirmed on repeat color Doppler imaging. At follow-up 6 and 12 weeks later, he had normal erectile function. Transarterial embolization appears to be a safe and effective treatment for managing patients with high-flow priapism.