ORIGINAL RESEARCH—ERECTILE DYSFUNCTION Posttraumatic Nonischemic Priapism Treated with Autologous Blood Clot Embolization Furuzan Numan, MD,* Murat Cantasdemir, MD,* Mustafa Ozbayrak, MD,* Oner Sanli, MD, † Ates Kadioglu, MD, † Aylin Hasanefendioglu, MD,* and Ahmet Bas, MD* *Department of Radiology, Division of Interventional Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey; † Department of Urology, Section of Andrology, Istanbul University Medical Faculty, Istanbul, Turkey DOI: 10.1111/j.1743-6109.2007.00560.x ABSTRACT Introduction. High-flow arterial priapism is rare and characterized by a prolonged nonpainful erection. Autologous clot embolization allows complete resolution of the problem in most of the cases. Aim. To review our experience with superselective transcatheter embolization in the treatment of nonischemic priapism. Main Outcome Measures. Advances in the understanding of the nonischemic priapism with the aid of newer techniques have altered the current management of nonischemic priapism. Materials and Methods. Between 2002 and 2006, 11 patients underwent superselective transcatheter embolization of nonischemic priapism with blunt trauma to the penis or perineum. All patients underwent diagnostic evaluation with color–flow Doppler ultrasound and superselective pudendal arteriography, revealing bilateral arteriocorporal fistula and pseudoaneurysm in two cases, bilateral arteriocorporal fistula in one case, unilateral arteriocorporal fistula in one case, and unilateral arteriocorporal fistula and pseudoaneurysm in seven cases. Autologous blood clot was used as an embolization agent in all cases combined with microcatheter guidance. Results. The procedure was technically successful in all cases. In three (27.2%) cases, a second embolization was required due to recurrence of priapism. In all patients, erectile function was restored within 6 weeks of the procedure. Follow-ups at 6 and 12 months after the last procedure revealed that full erectile capacity was restored in 10 of 11 patients, and these patients did not experience further recurrence of priapism. One patient reported a slight decrease in the quality of his penile erection. Conclusions. Our experience revealed that superselective transcatheter embolization and transient occlusion of the fistula with autologous blood clot is an effective therapy for the treatment of nonischemic priapism. Furthermore, recovery of erectile function due to recanalization of the occluded vessel occurred weeks after the procedure. Numan F, Cantasdemir M, Ozbayrak M, Sanli O, Kadioglu A, Hasanefendioglu A, and Bas A. Posttraumatic Nonischemic Priapism Treated with Autologous Blood Clot Embolization. J Sex Med 2008;5:173–179. Key Words. Priapism; Embolization; Autologous Blood Clot Introduction P riapism has been defined as a pathological condition of penile erection that persists beyond or is unrelated to sexual stimulation, which was first cited by Petraens in 1661 [1,2]. Three types of priapism are usually noted: (i) ischemic priapism, (ii) nonischemic pripiasm, and (iii) recur- rent priapism [3]. Among these, ischemic priapism is, per se, a urological emergency [4]. Because is- chemic priapism has the potential to cause erectile dysfunction (ED) through ischemic injury to caver- nous tissue, it necessitates early intervention and treatment [5–7]. Meanwhile, nonischemic pri- apism is a less common form that is caused by unregulated cavernous arterial inflow mostly due 173 © 2007 International Society for Sexual Medicine J Sex Med 2008;5:173–179