Ethylene-vinyl alcohol copolymer (Onyx ？ ) transarterial embolization for post-traumatic high-flow priapism

Priapism is a relatively rare condition characterized by a persistent erection lasting more than 4 hours in the absence of sexual stimulation (1). There are two main subtypes: the more common ischemic, or low-flow, characterized by the impaired outflow from the corpora cavernosa, and non-ischemic, or high-flow, most often caused by trauma, characterized by the formation of arterio-cavernous fistulas and increased inflow of blood to the corpora cavernosa (1). While the painful low-flow priapism and the associated decreased oxygenation of cavernous tissue can quickly lead to a cavernous fibrosis and permanent damage to penile tissues and is, therefore, an urological emergency, high-flow priapism is often painless and can persist for months, in most cases without a permanent damage of penile tissues, but sometimes with the reduced potency. Transarterial embolization of the distal internal pudendal arteries is the treatment of choice for high-flow priapism and a useful alternative to surgery (1,2). However, the choice of embolic agent remains a debate of matter (3). Here, we report a case of high-flow priapism caused by perineal trauma that was treated successfully with superselective embolization of the cavernous artery suing ethylene-vinyl alcohol copolymer liquid agent (Onyx？). The use of Onyx？ in such a setting has not been reported in the literature