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Non-ischemic priapism in pediatrics: A rare case managed with selective embolization
Arije Zouaoui, Oussema Meherzi, Yosra Kerkeni, Mariem Boukettaya, Riadh Jouini
Pediatric Surgery Department, Children's Hospital Bechir Hamza, Tunis, Tunisia
Introduction:
Priapism in children is a rare urological emergency, classifiable as ischemic, non-ischemic (arterial), or stuttering. Non-ischemic priapism is particularly uncommon in the pediatric population and typically follows perineal trauma. Its management remains non-consensual due to the scarcity of cases. We report a case of post-traumatic non-ischemic priapism in an 11-year-old boy and propose a diagnostic and therapeutic approach.
Case Presentation:
An 11-year-old boy, with no significant medical history, presented with priapism evolving for 48 hours following minor perineal trauma. Clinical examination revealed a painless, semi-rigid erection with a soft glans and normal penile skin coloration. Laboratory studies, including complete blood count and coagulation profile, were normal. Cavernosal blood gas analysis demonstrated a pH of 7.52 and oxygen saturation of 100%, consistent with non-ischemic priapism. Color Doppler ultrasound confirmed increased arterial inflow and identified two arterio-cavernosal fistulae within the proximal left and right corpus cavernosum. Conservative measures, including cavernosal aspiration, intracavernosal norepinephrine injection, direct fistula compression, local cooling, and bed rest over four days, resulted in only partial detumescence. Definitive management with bilateral selective embolization of the internal pudendal arteries achieved complete resolution. At 3-month follow-up, no recurrence was observed.
Conclusion:
Non-ischemic priapism in children is a rare entity that does not require urgent invasive intervention. Conservative management should be prioritized initially, while embolization offers an effective treatment in persistent cases. Further prospective studies are necessary to establish standardized guidelines regarding the optimal timing for intervention and the role of early embolization.