Downloaded from www.ajronline.org by 184.14.107.86 on 10/27/15 from IP address 184.14.107.86. Copyright ARRS. For personal use only; all rights reserved
329
I
Posttraumatic Autologous Andrew Paul 0.
B. Crummy,1 Madsen2
Conventional massage, spinal
Joanne
treatments ice packs,
ration,
tion,
Priapism: Successful Clot Embolization
anesthesia,
spongiosum
shunt,
treatments
lshizuka,1
of pniapism pressure
urethral
and
indicates
that
success
sequelae, primarily impotence, crosis, remain major problems The underlying pathophysiobogy of
arterial
reduce should,
inflow
relative
the inflow theoretically
of
permanently ply should interruption
clot,
restoration
the
that
wide
not been
variety
of
uniform
occasionally
and
tissue
of pniapism venous
blood at least,
caverno-
ne-
outflow.
Treatment
on increase be effective.
to
venous outflow In order not to
with
flow
reported to
a case
which a short
will
result
period
in
of time
artery
who
of posttraumatic of
the
internal
mm
after
pressure
had
patient with embolization
a similar
good
was
about
It could
minutes
24
hr and
be manually
but resumed
then
returned
compressed
its erect
to
state
3-4
released.
right,
such
The
contrast
tion.
The
and
subsequent left
surgery
(fig. remained
unchanged,
was
catheterized
was
passed
into
were
gluteal,
which
of the
the
trauma
shunt
the anterior
groin
failed.
left
upper
and
multiple
resulted
in
occlusion
had
trunk
The
extremity.
of
patient’s
patent
embolization,
the
of the
penis.
penis
When
seen
at 1 and 6 months
the
patient
(figs.
patient
The
clot
the
inferior
arteries.
The obtu-
1B
1 C).
and
reported
returned
catheter
autologous of
and the,vesical
remained The
that
trunk
pudendal,
complex
inferred
right
extravasainitial
so the next day the left hypogastric the
the anterior
the internal artery
the
an erection.
to the
to cannulate
from from
placed,
with
excluding
attributed
it was
1 A). An attempt artery
thereby
was
and
hypogastnic
in an individual
runs,
of staining
artery emboli
seen
between
asymmetry
thrombosed the
as is normally cleared
to normal
After
a decrease over
the
in
next
12
hr. and
intercourse.
posttraumatic of the internal
functional
for
state.
On the fifth hospital day, pelvic arteniography showed no evidence of the shunt. There was staining at the base of the penis on
turgidity
pudendal
semiflaccid
several
size within
rator
pniapism
was
normal
pniapism
clot after more standard treatments function was normal 3 months after
the procedure. We report another pniapism treated by transartenial pudendal
of
after
embolization
autologous [1 1. Sexual
failed
lysis
blood
penis
turgid
the
is an excess
The
to its preoperative
completion
responded
had
has but [11.
natural
of normal
3]. We previously
artery
The
penis.
impair function, any interruption of arterial supbe temporary. A method for achieving temporary of arterial flow is to occlude the inflow with
autologous [2,
to
have included aspidressing, hepaniniza-
ligation.
with
and
catheterization,
arterial
Treatment
reported
he had
Telephone
indicated
no
follow-up, normal
conversation
change
had
the penis
erections 1 8 months
was normal
and after
satisfactory embolization
occurred.
result. Discussion
Case
Posttraumatic
Report
pniapism
experience
A 49-year-old gunshot wound right
thigh,
thigh.
man, seen because of pniapism, had sustained a 3 weeks before with the bullet passing through the
the
scrotum
He developed
mained
wounds.
despite
examination hematomas The day after
nosum-spongiosum
Received Administration
AJR
shunt
November
I Department
Department 133:329-330,
the
a persistent
unchanged
Physical resolving
2
near
14,
sitz
base
of the
erection baths
and
penis,
4 days
August
into
earlier
intravenous
the
left
that
re-
heparin.
was normal except for the penile erection, of both thighs, and healing cutaneous admission, a right unilateral corpus caverwas
1978;
established
accepted
at
after
William 1979;
S. Middleton 0361 -803X/79/
the
revision
of Radiology, University of Wisconsin Hospital, Madison, WI 53705. Address
of Surgery.
and
midshaft
April
of
25,
Administration
1332-0329
ply
success to
any
of
the
in
an
embolizatio#{241}
two
In one
uncommon
cases
case
of
of
tion as to his cooperation. gous clots make the
The occlusion
against
effects.
term
side
method
spontaneous
spontaneous self-limited
is
and limited.
of the arterial
posttraumatic
treatment was unsuccessful. In that case, frankly psychotic sexual deviate and there
long
condition,
treatment
intraarterial
penis
encouraging.
is
particular
supis
pniapism pniapism,
the patient was some
similar
was a ques-
lysis of autoloand protects
1979.
Clinical Science reprint requests
Veterans
the
The
with
$00.00:
Center, 600 Highland to A. B. Crummy.
Hospital, © American
Madison, Roentgen
Ave.
,
Madison,
WI 53705. Ray Society
WI 53792,
and William
S. Middleton
Veterans
Downloaded from www.ajronline.org by 184.14.107.86 on 10/27/15 from IP address 184.14.107.86. Copyright ARRS. For personal use only; all rights reserved
330
CASE
REPORTS
AJR:133,
August
1979
r.4m
,.1 Fig.
1 -Abdominal
at right trauma.
aortograrns.
A, Late
arterial
phase.
base of penis. Lack of staining on left side Density extending obliquely across scrotum
on drape.
B. Selective
injection
into anterior
Unilateral
believed due due to spill
trunk
of left internal
staining to previous of contrast
iliac artery.
Blood supply to penis with dense staining on right. Bullet in soft tissues. C. After embolization, no longer staining at base of penis. Arterial supply from left hypogastric obliterated. Some minor extravasation of contrast due to overloading of system with catheter wedged. Patient experienced decreased turgidity at this time.
C
REFERENCES hemorrhage 1
.
Wear treatment
2.
Kalish
JB
Jr,
Crummy
of priapism. M, Greenbaum
AB,
Munson
BO:
A new
J Urol
1 1 7 : 252-254,
L, Silber
S, Goldstein
approach
to the
1977 H: Traumatic
138-141,
3. rena
Silber
treatment
by
arterial
embolization.
J Urol
1 1 2:
1974
5: Renal
autologous
clot.
trauma. Arch
Treatment Surg
by angiographic
1 1 0 : 206-208,
1975
injection
of
329
I
Posttraumatic Autologous Andrew Paul 0.
B. Crummy,1 Madsen2
Conventional massage, spinal
Joanne
treatments ice packs,
ration,
tion,
Priapism: Successful Clot Embolization
anesthesia,
spongiosum
shunt,
treatments
lshizuka,1
of pniapism pressure
urethral
and
indicates
that
success
sequelae, primarily impotence, crosis, remain major problems The underlying pathophysiobogy of
arterial
reduce should,
inflow
relative
the inflow theoretically
of
permanently ply should interruption
clot,
restoration
the
that
wide
not been
variety
of
uniform
occasionally
and
tissue
of pniapism venous
blood at least,
caverno-
ne-
outflow.
Treatment
on increase be effective.
to
venous outflow In order not to
with
flow
reported to
a case
which a short
will
result
period
in
of time
artery
who
of posttraumatic of
the
internal
mm
after
pressure
had
patient with embolization
a similar
good
was
about
It could
minutes
24
hr and
be manually
but resumed
then
returned
compressed
its erect
to
state
3-4
released.
right,
such
The
contrast
tion.
The
and
subsequent left
surgery
(fig. remained
unchanged,
was
catheterized
was
passed
into
were
gluteal,
which
of the
the
trauma
shunt
the anterior
groin
failed.
left
upper
and
multiple
resulted
in
occlusion
had
trunk
The
extremity.
of
patient’s
patent
embolization,
the
of the
penis.
penis
When
seen
at 1 and 6 months
the
patient
(figs.
patient
The
clot
the
inferior
arteries.
The obtu-
1B
1 C).
and
reported
returned
catheter
autologous of
and the,vesical
remained The
that
trunk
pudendal,
complex
inferred
right
extravasainitial
so the next day the left hypogastric the
the anterior
the internal artery
the
an erection.
to the
to cannulate
from from
placed,
with
excluding
attributed
it was
1 A). An attempt artery
thereby
was
and
hypogastnic
in an individual
runs,
of staining
artery emboli
seen
between
asymmetry
thrombosed the
as is normally cleared
to normal
After
a decrease over
the
in
next
12
hr. and
intercourse.
posttraumatic of the internal
functional
for
state.
On the fifth hospital day, pelvic arteniography showed no evidence of the shunt. There was staining at the base of the penis on
turgidity
pudendal
semiflaccid
several
size within
rator
pniapism
was
normal
pniapism
clot after more standard treatments function was normal 3 months after
the procedure. We report another pniapism treated by transartenial pudendal
of
after
embolization
autologous [1 1. Sexual
failed
lysis
blood
penis
turgid
the
is an excess
The
to its preoperative
completion
responded
had
has but [11.
natural
of normal
3]. We previously
artery
The
penis.
impair function, any interruption of arterial supbe temporary. A method for achieving temporary of arterial flow is to occlude the inflow with
autologous [2,
to
have included aspidressing, hepaniniza-
ligation.
with
and
catheterization,
arterial
Treatment
reported
he had
Telephone
indicated
no
follow-up, normal
conversation
change
had
the penis
erections 1 8 months
was normal
and after
satisfactory embolization
occurred.
result. Discussion
Case
Posttraumatic
Report
pniapism
experience
A 49-year-old gunshot wound right
thigh,
thigh.
man, seen because of pniapism, had sustained a 3 weeks before with the bullet passing through the
the
scrotum
He developed
mained
wounds.
despite
examination hematomas The day after
nosum-spongiosum
Received Administration
AJR
shunt
November
I Department
Department 133:329-330,
the
a persistent
unchanged
Physical resolving
2
near
14,
sitz
base
of the
erection baths
and
penis,
4 days
August
into
earlier
intravenous
the
left
that
re-
heparin.
was normal except for the penile erection, of both thighs, and healing cutaneous admission, a right unilateral corpus caverwas
1978;
established
accepted
at
after
William 1979;
S. Middleton 0361 -803X/79/
the
revision
of Radiology, University of Wisconsin Hospital, Madison, WI 53705. Address
of Surgery.
and
midshaft
April
of
25,
Administration
1332-0329
ply
success to
any
of
the
in
an
embolizatio#{241}
two
In one
uncommon
cases
case
of
of
tion as to his cooperation. gous clots make the
The occlusion
against
effects.
term
side
method
spontaneous
spontaneous self-limited
is
and limited.
of the arterial
posttraumatic
treatment was unsuccessful. In that case, frankly psychotic sexual deviate and there
long
condition,
treatment
intraarterial
penis
encouraging.
is
particular
supis
pniapism pniapism,
the patient was some
similar
was a ques-
lysis of autoloand protects
1979.
Clinical Science reprint requests
Veterans
the
The
with
$00.00:
Center, 600 Highland to A. B. Crummy.
Hospital, © American
Madison, Roentgen
Ave.
,
Madison,
WI 53705. Ray Society
WI 53792,
and William
S. Middleton
Veterans
Downloaded from www.ajronline.org by 184.14.107.86 on 10/27/15 from IP address 184.14.107.86. Copyright ARRS. For personal use only; all rights reserved
330
CASE
REPORTS
AJR:133,
August
1979
r.4m
,.1 Fig.
1 -Abdominal
at right trauma.
aortograrns.
A, Late
arterial
phase.
base of penis. Lack of staining on left side Density extending obliquely across scrotum
on drape.
B. Selective
injection
into anterior
Unilateral
believed due due to spill
trunk
of left internal
staining to previous of contrast
iliac artery.
Blood supply to penis with dense staining on right. Bullet in soft tissues. C. After embolization, no longer staining at base of penis. Arterial supply from left hypogastric obliterated. Some minor extravasation of contrast due to overloading of system with catheter wedged. Patient experienced decreased turgidity at this time.
C
REFERENCES hemorrhage 1
.
Wear treatment
2.
Kalish
JB
Jr,
Crummy
of priapism. M, Greenbaum
AB,
Munson
BO:
A new
J Urol
1 1 7 : 252-254,
L, Silber
S, Goldstein
approach
to the
1977 H: Traumatic
138-141,
3. rena
Silber
treatment
by
arterial
embolization.
J Urol
1 1 2:
1974
5: Renal
autologous
clot.
trauma. Arch
Treatment Surg
by angiographic
1 1 0 : 206-208,
1975
injection
of
