外傷性持続勃起症の1例

Abstract

48歳男.9日前に交通事故で股関節を打撲し近医を受診し, 外傷性持続勃起症を疑われた.陰茎硬度が不完全で疼痛を伴わず, 陰茎海綿体内血液ガス分析が動脈血に酷似したものであるため, 動脈性流入過剰型持続勃起症を疑った.内陰部動脈造影で左右の内陰部動脈の分岐部付近から陰茎海綿体洞への造影剤の容易な溢流を認めたため, 左内陰動脈に対し自己凝血塊による塞栓術を行った.しかし, すぐに再開通してしまうため可溶性ゼラチンスポンジを用いて塞栓術を行った.続いて右内陰動脈に対してもゼラチンスポンジを用いて塞栓術を行ったところ, 数分後には勃起は消失した.術後11ヵ月, 再発および勃起不全の発生を認めない

A 48-year-old man, who previously had normal erectile function, visited our hospital complaining of a painless erection that had persisted for 6 days. He had suffered perineal trauma in a traffic accident 9 days earlier. A diagnosis of post-traumatic high-flow priapism was suggested from the findings on penile blood gas analysis. Selective internal pudendal arteriography showed an arterial blush along the bilateral cavernous arteries. Subsequently, embolization of a cavernous fistula was performed with an autologous clot. However, the embolus was removed within a minute, so the procedure was repeated with Gelfoam. This patient had normal erectile function after 11 months, with no recurrence of priapism.