Super-selective arterial embolization in the therapy of non-ischemic priapism—a single-center study and literature review

TL;DR

This study shows that arterial embolization is a safe and effective treatment for non-ischemic priapism when other methods fail.

Contribution

The study provides long-term clinical data and technical insights on super-selective arterial embolization for non-ischemic priapism.

Findings

Technical success was achieved in 93.3% of patients undergoing arterial embolization.

No new cases of erectile dysfunction were reported after the procedure.

Arterial embolization improved symptoms long-term without significant sexual function impairment.

Abstract

The goal of our analysis is to provide technical information and clinical long-term data on arterial embolization for non-ischemic priapism. Furthermore, this study presents a comprehensive literature review.

We analyzed patient data from June 2005 to June 2025 at a large university hospital, focusing on patients with non-ischemic priapism lasting over 1 week, unresponsive to conservative treatment, and referred for arterial embolization. Age, symptom etiology, initial diagnostic modality, embolic agent, uni- or bilateral arterial supply of the fistula/pseudoaneurysm, technical success, clinical outcome, need for a second attempt, erectile dysfunction, adverse events, and mean follow-up time needed were assessed. Findings were contextualized with studies from the past two decades.

A total of 15 male patients with non-ischemic priapism due to blunt, penetrating trauma or of idiopathic origin, were included in this analysis. The embolic agents chosen included gelatin sponge, polyvinyl alcohol particles, autologous clot, microcoils, and a combination of microcoils with gelatin sponge or polyvinyl alcohol particles. Technical success was achieved in 14 patients (93.3%). A second or third intervention was needed in three cases (20.0%) to achieve clinical success. Documented adverse events included procedure-related findings such as penile skin changes and deviation in two patients (13.3%). No new cases of erectile dysfunction were reported (0%).

Our findings support super-selective arterial embolization as a safe, technically successful, and minimally invasive therapy option for non-ischemic priapism after conservative measures fail. Moreover, our data suggest that arterial embolization is associated with long-term symptom improvement without significantly impairing sexual function.

The online version contains supplementary material available at 10.1186/s42155-026-00672-0.

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