Post-traumatic priapism treated with selective cavernosal artery ligation.

Two cases of post-traumatic high-flow priapism after blunt trauma to the penis are presented. Diagnosis of high-flow priapism was accomplished with the use of both color-flow Doppler ultrasound and arteriography, which demonstrated arteriocorporal fistulas. In each patient, angiographic embolization was attempted but abandoned because the distal artery feeding the fistula could not be safely catheterized. Both patients were definitively treated with surgical ligation of the arteriovenous fistula, guided by intraoperative ultrasound. Operative management with arterial ligation provides a safe, selective, and effective alternative treatment to embolization. Two surgical approaches are discussed, one extracorporal and the other transcorporal. We believe that although transcorporal dissection poses increased risks, it is appropriate for arterial priapism of prolonged duration, especially if a well-formed vascular pseudocapsule is identified.