High-flow Priapism (HFP) is an extremely rare condition. It may affect the erectile function in a third of the patients. This study aimed to evaluate the efficacy of various treatment methods and the risk for erectile dysfunction (ED) in such cases.

Between January 2000 and June 2006, 15 patients with priapism were treated in our department. The investigative protocol (including assessment of patientʼs history, clinical examination, blood tests, Doppler ultrasonography and cavernous blood gases) identified 6 patients with HFP. Erectile function after treatment was assessed using the IIEF questionnaire. Penile Doppler ultrasonography evaluation was performed in patients with erectile dysfunction.

The cause of HFP was perineal and/or genital trauma in 5 cases. No etiologic cause was identified in the other case. Spontaneous resolution was encountered in one case. Angiography with selective embolization of the cavernous artery was necessary in the other 5 cases. Repeated embolization was necessary in one case. Four patients - including the spontaneous resolved case - (66.7%), reported preserved erectile function at 1 year after treatment. In these patients, Doppler ultrasonography described the rechanelling of the cavernous artery without fistula recurrence. In the other 2 patients (33.3%), subsequent persistent deterioration of the erectile function was reported, with no rechanelling of the cavernous arteries.

In patients with HFP, selective embolization may be a safe and effective treatment option. The spontaneous rechanelling of the cavernous arteries is probably responsible for sexual functionʼs preservation in these patients.