High-flow priapism after pelvic fracture

Romain Carlat (1), Renaud Destraix (4), Nicolas Jacquemart (2), François Melebeck (3), Michaël Twahirwa (4), Michaël De Foy (3) Published in the journal : October 2023 Category : Chirurgie orthopédique

Summary :

Priapism is an erectile dysfunction characterized by partial or complete penile erection lasting more than four hours without any sexual stimulation. Its incidence is estimated at 0.5-0.9 cases per 100,000 people per year. Ischemic priapism, which is more frequent and painful, is induced by the paralysis of the cavernous smooth muscle, which can no longer contract, allowing hypoxic blood to stagnate within the sinusoidal spaces. Arterial priapism, rare (5% of priapism) and typically painless, generally results from direct perineal trauma responsible for an arterio-cavernous fistula. In this case report, we discuss the multidisciplinary management of a 31-year-old patient, polytraumatized after a high-velocity motorcycle accident. He presented with a pelvic fracture osteosynthesized with a plate and screws. Following surgery, the patient developed post-traumatic high-flow priapism, which was managed by interventional radiology.

What is already known about the topic?

The mechanism of priapism is well known, and three types can be distinguished: ischemic priapism (venous/low-flow), arterial priapism (non-ischemic/high-flow), and intermittent priapism. High-flow priapism is easy to recognize in the context of perineal or penile trauma, but it is rare and should not go unnoticed in our patients. There are multiple therapeutic approaches, but most authors recommend hyper-selective embolization.

What does this article bring up for us?

High-flow priapism is rare and should not be overlooked by physicians managing pelvic and perineal trauma. We briefly review the genesis and evolution of this pathology linked to a post-traumatic arteriovenous fistula in the corpus cavernosum. This article also highlights the success of hyper-selective embolization, with clear and precise illustrations.


Polytrauma, pelvic fracture, priapism, arteriovenous fistula, embolization