Endovascular treatment of traumatic penile arteriospongious fistula in a patient with erectile dysfunction: a case report and literature review

BACKGROUND: An arteriovenous fistula is an abnormal communication between an artery and a vein. Traumatic penile arteriospongious fistula is a rare complication and has been described as a cause of erectile dysfunction. Clinical evaluation of patients with erectile dysfunction after penile trauma includes a thorough history, physical examination, vascular assessment, and other complementary exams. Treatment consists of endovascular embolization, surgical ligation, or a combination of both techniques. CASE PRESENTATION: A 40-year-old man presented with erectile dysfunction that had persisted since suffering blunt trauma a few months ago. He reported problems with short duration of erection and insufficient penile tumescence. Due to high suspicion of an arteriovenous fistula, he was referred to angiography, which confirmed the diagnosis of an abnormal connection between the pudendal vessels. The patient was treated with the coil embolization technique and the symptoms were successfully resolved after endovascular treatment. CONCLUSIONS: The appearance of a post-traumatic arteriospongious fistula is a rare complication with almost non-existent literature reported. Rapid development in endovascular techniques, in which we use embolic agents to block anomalous blood flow, has allowed safe, effective and less invasive alternative to surgery. Our case demonstrates that endovascular approach is a successful treatment for post-traumatic arteriospongious fistula since the symptoms were resolved, and normal erectile function was regained after the intervention.