A rare case of post-traumatic high-flow priapism requiring endovascular salvage with bilateral superselective microcoil embolization

Post-traumatic high-flow priapism is a rare occurrence, with potentially debilitating long-term erectile dysfunction if left unaddressed. Even rarer, however, is for the priapism symptoms to be caused by a single cavernosal arterial pseudoaneurysm, with feeding vessels from the distal branched vessels of ‘both’ the left and right internal pudendal arteries. To the best of our knowledge, we present the first documented case of endovascular salvage utilizing superselective microcoil embolization in the treatment of high-flow priapism caused by a singular pseudoaneurysm with bilateral inflow. Timing of symptoms, interpretation of imaging, multidisciplinary discussions, procedural risk, arterial anatomy and choice of embolic agent were all careful considerations in this case. Following embolization, this young gentleman ultimately had a successful angiographic result, normalization of his cavernosal artery peak systolic velocity on ultrasound and a full return to normal erectile function by 6 months.