Prepubertal high flow priapism: Incidence, diagnosis and treatment

Purpose: We reviewed the literature of the last 40 years and report our exp erience with treating high flow priapism with fistula embolization in prepu bertal boys. Materials and Methods: Two boys had blunt perineal trauma and 1 had penile trauma (ages 6, 6 and 10 years). Painless priapism developed within 24 hour s and lasted for 4 to 7 days before the patients presented to the hospital. Primary diagnosis was made on color Doppler ultrasound. When high flow pri apism was diagnosed angiography of the internal iliac artery and embolizati on of the arteriocavernosal fistula were performed. Mean followup was 26 mo nths. Results: Color Doppler ultrasound revealed bilateral arteriocavernosal fist ulas in 2 boys and a unilateral fistula in 1. Angiography showed fistulas o f the branches of the internal pudendal artery in 2 patients and fistulas o f the bulbourethral artery in 1. Microcoils were used in the bulbourethral artery and a gelatin sponge was used in other penile arteries. Complete det umescence with restored erectile function was achieved in all cases. Conclusions: High flow priapisin in children can be diagnosed easily by typ ical clinical features combined with color Doppler ultrasound. In children with posttraumatic priapism embolization of the arteriocavernosal fistula i s superior to surgical or medical procedures and should be the first line t herapy. Embolization using microcoils for bulbourethral arteries and a gela tin sponge for other penile arteries has proved to be safe and successful t herapy.