Evolving concepts in the diagnosis and treatment of arterial high flow priapism.

Abstract

We investigated 2 evolving concepts in the management of arterial priapism: 1) the efficacy of perineal duplex Doppler ultrasound as a diagnostic alternative to arteriography and 2) the therapeutic alternative of expectant management. We evaluated 10 patients with high flow arterial priapism. Compared to selective internal pudendal arteriography, perineal duplex Doppler ultrasonography was associated with 100% sensitivity and 73% specificity rates. Compared to physical examination, followup duplex ultrasonography had a sensitivity of 75% and specificity of 100%. Followup penile duplex ultrasound demonstrated restoration of antegrade flow in the cavernous artery after embolization. Patients on expectant management remained potent as long as 31 years. Diagnostic perineal duplex Doppler ultrasonography and expectant management are valuable tools for the treatment of arterial priapism. A new algorithm for patient care is presented.