A case of proximal partial priapism successfully treated with autologous clot embolisation

[Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) : A rare urological emergency]

BACKGROUND

Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) is a rare, semi-acute disease in young, healthy men. In addition to an anatomical predisposition, perineal microtrauma is stated as the main risk factor.

MATERIALS AND METHODS

A case report and the results of a literature search with descriptive-statistical processing of 57 peer-reviewed publications are presented. A therapy concept was drawn up for clinical practice.

RESULTS

Our patient was treated conservatively and was consistent with the 87 cases which have been published since 1976. IPTCC is a disease of young men (33.2 years, range 18-70), which is associated with pain and perineal swelling in 88%. Sonography and contrast-enhanced magnetic resonance imaging (MRI) proved to be the diagnostic modality of choice, demonstrating the thrombus and in 89% a connective tissue membrane inside the corpus cavernosum. Treatment included antithrombotic and analgesic (n = 54, 62.1%), surgical (n = 20, 23%), analgesic (n = 8, 9.2%), via injection (n = 2, 2.3%), as well as radiological interventional (n = 1, 1.1%) options. In 12 cases, erectile dysfunction, mostly temporary, which required phosphodiesterase (PDE)-5 therapy developed. Recurrence and prolonged courses were rare.

CONCLUSION

IPTCC is a rare disease in young men. Conservative therapy with antithrombotic and analgesic treatment has shown good chances of full recovery. If relapse occurs or the patient refuses antithrombotic treatment, operative/alternative therapy management should be considered.

Autologous Blood-Clot Embolisation of Iatrogenic Femoral Artery Pseudoaneurysm Caused by Arterial Sheath Placement; A Case Report

Iatrogenic Femoral Artery Pseudoaneurysm (FAP) is a common complication that occurs in diagnostic and therapeutic catheterization procedures and can cause morbidity and even mortality in patients. Aneurysm larger than 2 cm, symptomatic or complicated should be treated. Here we report a 59-year-old man with post-catheterization FAP following femoral artery angiography, treated successfully by direct transcatheter autologous blood clot embolisation. To the best of our knowledge, our case report is the first to demonstrate that FAP can be successfully treated endovascularly by autologous blood clot embolisation.

Surgical Management of Idiopathic Partial Thrombosis of the Corpus Cavernosum

A 36-year-old African American man presented to the emergency department with 2 days of left-sided perineal pain after sexual activity. He was found to have induration in the left perineum overlying the proximal left corporal body. Clinical picture was suspicious for traumatic corporal rupture; however, advanced imaging showed a proximal segmental thrombosis of the left corpus cavernosum. The patient underwent perineal exploration with evacuation of an intracorporal penile hematoma. In spite of disrupting a fibrous membrane in the proximal corpora and drainage of the corpora, we observed repeat tumescence during the procedure because of an observed arterial high-flow state in the corpora cavernosum. This was resolved with administration of phenylephrine into the cavernosum. The patient had return of normal erectile function 2 days after the procedure with resolution of pain at the site. Singh D, Larson T, Campbell K, et al. Surgical Management of Idiopathic Partial Thrombosis of the Corpus Cavernosum. Sex Med 2021;9:100273.