high flow priapism treatment

Online ahead of print. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Sex Med. Evidence seems to suggest that trazodone exclusively causes low-flow priapism. Would you like email updates of new search results? BJU International. Venous blood is evident on aspiration of the corpora cavernosa. The management is slightly different but follows the same principles for the sickle cell anemia variant of veno-occlusive priapism.3,4 High-flow priapism treated with selective embolization of a helicine branch of the penile artery: A case report and selected review of the literature. Inferior rectal (or inferior hemorrhoidal) branches at the level of the ischial tuberosity Bethesda, MD 20894, Web Policies Priapism is a pathologically persisting erection of the penis not associated with sexual stimulation. 1. 2017; doi:10.1111/bju.13717. Priapism is a medical emergency, and if not treated within 24 hours, leads to irreversible ischemia and tissue necrosis. and transmitted securely. See this image and copyright information in PMC. Up to 70% of men with ED remain undiagnosed and untreated. 25% . With nonischemic priapism, the prognosis is often good since the blood supply to the penis is not compromised, just disrupted. This provides a clue to the type of priapism, how long the condition has been present, and how much damage has occurred. e81-1). The EAU Annual Congress 2019 achieved the Patients Included status. This is the most common type. Treatment of "high-flow" priapism with superselective transcatheter embolization: a useful alternative to surgery. Priapism is one of the most common urologic emergencies. "Stuttering" priapism is a term frequently used to . Intracavernous vasodilator injections for treatment of ED, Postembolization or surgery for venous leak. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. It is the result of a ruptured artery from an injury to the penis or the perineum (the area between the scrotum and anus), which prevents blood in the penis from circulating normally. Based on these cases and a review of the literature, we outline a modified diagnostic and therapeutic approach for patients with high flow arterial priapism. Thus, the penis has three pairs of arteries: two urethral arteries that run on either side of the penile urethra in the corpus spongiosum, two cavernosal arteries, each running on the center of the corpus cavernosum, and two dorsal arteries of the penis running on either side of the dorsum of the penis between the tunica albuginea and Buck fascia, near the dorsal nerves of the penis.26 Partin AW, et al., eds. The AUA recommends that the initial evaluation of ED include a complete medical, sexual, and psychosocial history.17 History and physical examination are sufficient to make an accurate diagnosis of ED in most cases.12 The five-item version of the International Index of Erectile Function Questionnaire (IIEF-5) is a validated survey instrument that can be used to assess the severity of ED symptoms.18, Although erectile function can improve after vascular reconstructive surgery or endovascular angioplasty of the internal pudendal/penile arteries,20-23 there is still very little evidence to recommend vascular imaging studies and therapies for ED in the general population. However, only your doctor can distinguish between high- and low-flow priapism. In cases of ischemic priapism, if it is treated early and successfully, erectile function should return to normal. Analytical cookies are used to understand how visitors interact with the website. Instead, get emergency help as soon as possible. Keywords: Please enable it to take advantage of the complete set of features! Putting ice packs and pressure on the perineum the region between the base of the penis and the anus might help end the erection. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Superselective embolization of terminal branches of the male internal pudendal artery is a highly successful procedure in the treatment of high-flow arterial priapism. Less common than the low-flow type; in adults, 80% to 90% have a single fistula causing the priapism, but in children, 50% have multiple fistulas. We report on the management and long-term follow-up of patients treated for high-flow priapism in our clinic between 1995 and 1998. Epub 2018 Dec 3. Medications. Purpose: To evaluate the effectiveness and safety of treatment of high-flow priapism (HFP) with superselective transcatheter embolization at nine university hospitals. doi: 10.1093/jscr/rjab077. 2013 Dec;54(12):816-23. doi: 10.4111/kju.2013.54.12.816. 2019 Sep-Oct;52(5):331-336. doi: 10.1590/0100-3984.2018.0035. HHS Vulnerability Disclosure, Help Appropriate management of high-flow priapism based on color Doppler ultrasonography findings in pediatric patients: four case reports and a review of the literature. High-flow, non-ischemic priapism is a rare condition, with which many urologists and andrologists are unfamiliar. J Urol 1994;151: 878-9. doi: 10.1016/j.jpurol.2019.01.005. Typically a straddle injury to the perineum, Sometimes results from complications of low-flow priapism, Can be idiopathic without a recognizable event. Priapism can occur in all age groups, including newborns. Presumptive Non-Ischemic Priapism in a Cat. Failure of the veins to close completely during an erection (veno-occlusive dysfunction) may occur in men with large venous channels that drain the corpora cavernosa, and may be studied by cavernosography.13 Evidence is accumulating in favor of ED as a vascular disorder in the majority of patients.14. The onset is usually delayed after injury, but typically it is clinically evident within 72 hours. . Nitric oxide causes smooth muscle relaxation, which leads to arterial influx of blood into the corpus cavernosum, followed by compression of venous return, producing an erection. Last reviewed by a Cleveland Clinic medical professional on 10/14/2019. ( a ), MeSH 12th ed. More rigorous trials are needed to prove short- and long-term effectiveness.19, Duplex sonography with pulsed Doppler analysis (with and without dynamic erection studies with vasoactive substances) and nocturnal penile tumescence (NPT) are usually performed as first-line studies. Accessed April 20, 2021. This branch most frequently replaces the dorsal artery of the penis and deep branches of the internal pudendal artery (with the internal pudendal artery terminating as the bulbar artery or with perineal branches). High flow priapism: Also known as "nonischemic," high flow priapism is rare and . This website uses cookies to improve your experience. Don't stop taking any prescription medications without consulting your doctor. Nonischemic (arterial, high flow) priapism is a nonsexual, persistent erection caused by unregulated cavernous arterial inflow. Arrichiello A, Angileri SA, Buccimazza G, Di Bartolomeo F, Di Meglio L, Liguori A, Gurgitano M, Ierardi AM, Papa M, Paolucci A, Carrafiello G. Acta Biomed. The determination of erectile function at a mean follow-up of 41 months (range 17 to 64) was performed using the International Index of Erectile Function. Muscular (small branches) In patients with priapism secondary to other disorders, attempt to treat the underlying condition. Shapiro RH, Berger RE. Before 2020 Mar;125(3):288-295. doi: 10.1007/s11547-019-01113-w. Epub 2019 Dec 10. Priapism is a genitourinary emergency that demands a thorough, time-sensitive evaluation. High-flow priapism is caused by an injury that damages an artery supplying blood to the penis, causing it to be oversupplied with oxygen-rich blood. Tiago Bilhim, Joo M. Pisco, Max Kupershmidt and Kenneth R. Thomson This exam might also reveal the presence of a tumor or signs of trauma. After the final revisions were made based . Int J Impot Res 2005; 17:109. Transl Androl Urol. The internal pudendal artery arises from the anterior division of the internal iliac artery, with a typical trajectory curving under the sciatic notch that enables easy recognition.25 The artery enters the perineum via the lesser sciatic foramen and runs along the lateral wall of the ischiorectal fossa between the split layers of the obturator fascia in the Alcock canal to the inferior pubic ramus (Fig. Disclosure The author has no financial or nonfinancial conflicts relevant to this article. First-line treatment is aspiration that confirms the diagnosis and at the same time decompresses. Failure of the veins to close completely during an erection (veno-occlusive dysfunction) may occur in men with large venous channels that drain the corpora cavernosa, and may be studied by cavernosography. Mayo Clinic does not endorse companies or products. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. Thus, the penis has three pairs of arteries: two urethral arteries that run on either side of the penile urethra in the corpus spongiosum, two cavernosal arteries, each running on the center of the corpus cavernosum, and two dorsal arteries of the penis running on either side of the dorsum of the penis between the tunica albuginea and Buck fascia, near the dorsal nerves of the penis. Duplex sonography with pulsed Doppler analysis (with and without dynamic erection studies with vasoactive substances) and nocturnal penile tumescence (NPT) are usually performed as first-line studies. MeSH This treatment often relieves pain, removes oxygen-poor blood and might stop the erection. PMID: 8126815. Prevalence increases with age: 12% are younger than 59 years, 22% are 60 to 69, and 30% are older than 69.11. This website uses cookies to improve your experience while you navigate through the website. Unauthorized use of these marks is strictly prohibited. Please enable it to take advantage of the complete set of features! To determine the long-term follow-up of treatment of high-flow priapism, we reviewed the case records of 10 patients who were examined by the Urologic Clinic in Trieste from 1995 to 1998. If conservative treatment fails, then treatment option includes either surgery or endovascular embolisation. Treatment of High-flow Priapism with Superselective Transcatheter Embolization in 27 Patients: A Multicenter Study - Journal of Vascular and Interventional Radiology Skip to Main Content HHS Vulnerability Disclosure, Help PMC Chapter 81 e81-1). If you have priapism, it is important to get medical care immediately. A normal sexual erectile response results from the production of nitric oxide from endothelial cells after parasympathetic stimuli. When left untreated, priapism may result in the following complications: Does priapism go away on its own? Journal of Urology. The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. Management Low flow priapism is ischemic and a true urologic emergency - a compartment syndrome of the penis, whereas high flow is non-ischemic. FOIA Priapism is prolonged erection that persists beyond or is unrelated to sexual stimulation. There are two main types of priapism: high flow and low flow. Ischemic or "low-flow" priapism occurs when blood disorders (such as sickle cell anemia or leukemia), prescription medication, or substance use cause the veins in the penis to constrict and keep blood from exiting the erection chambers (corpora cavernosa). Low-flow priapism is caused by decreased outflow of blood due to venous thrombosis; thus there results a compartment syndromelike pathophysiology, with the risk of gangrene. Here's some information to help you prepare for your appointment, and what to expect from your doctor. Angiographic embolization of the lacerated artery is currently considered the treatment of choice. Stuttering Priapism in a Dog-First Report. Perineal-scrotal artery, supplying the perineal muscles, structures between anus and scrotum, skin and dartos tunic of the scrotum Are there activities, such as exercise or sex, that should be avoided? High-flow priapism: This is rarer and is usually not painful. Priapism is divided into two variants, ischemic priapism (IP, formerly known as low-flow or veno-occlusive priapism) and non-ischemic (NIP, formerly known as high-flow or arterial priapism). Federal government websites often end in .gov or .mil. Diagnostic and therapeutic options for the management of ischemic and nonischemic priapism. High-flow priapism: treatment and long-term follow-up - ScienceDirect Urology Volume 59, Issue 1, January 2002, Pages 110-113 Adult urology High-flow priapism: treatment and long-term follow-up Sandro Ciampalini a , Gianfranco Savoca a , Lorenzo Buttazzi a , Ignazio Gattuccio a , Fabio Pozzi Mucelli b , Michele Bertolotto b , Stefano De Stefani a , Vascular imaging and treatment in patients with erectile dysfunction (ED) using cavernosography and internal pudendal artery angiography and angioplasty remains a controversial topic. High flow priapism is not emergency and may be managed conservatively with medical treatment such as androgen blockade agents as well as embolization Stuttaring priapism a form of LFP and treatable with medical treatment of LFP as well as terbutaline, digoxin, antiandrogens, Gabapentin, PDE5-I Bookshelf American Urological Association (AUA) guidelines. The most common anatomic variation is the accessory pudendal artery, which arises from the internal iliac or internal pudendal arteries within the pelvis and passes below the pubic symphysis along the anterior-lateral aspect of the prostate, below the bladder (see Fig. Clinical Presentation . The ruptured branch of the cavernous artery was ligated in an open procedure. Repeat penile corporal blood gas analysis reaffirmed the priapism to be non-ischemic in nature, and it was decided to manage the patient conservatively. Intracavernous vasodilator injections for treatment of ED High-Flow/Nonischemic/Arterial Priapism However, only your doctor can distinguish between the two types or priapism. The most common anatomic variation is the accessory pudendal artery, which arises from the internal iliac or internal pudendal arteries within the pelvis and passes below the pubic symphysis along the anterior-lateral aspect of the prostate, below the bladder (see Fig. Gimbergues P, Raynaud F, Ravel A, Perez N, Guy L, Boiteux JP, Boyer L. Santi D, Spaggiari G, Simoni M, Granata ARM. Postembolization or surgery for venous leak e81-1). Careers. Low flow is far more common, with high flow only making up about 2% of presentations. There are two types of priapism, ischemic (low-flow) and nonischemic (high-flow), and treatment varies depending on the type, its severity, and the underlying cause. Munshi FI, Kwon YS, Gibbens DT, Mahmood P, Gazi M, Olweny EO. Failure of the veins to close completely during an erection (veno-occlusive dysfunction) may occur in men with large venous channels that drain the corpora cavernosa, and may be studied by cavernosography.13 Evidence is accumulating in favor of ED as a vascular disorder in the majority of patients.14 What are the causes behind priapism Other treatment options include: If you think that you are experiencing priapism, you should not attempt to treat it yourself. and transmitted securely. Clinical Presentation Accessibility Materials and Methods: Between May 1994 and October 2006, 27 patients underwent superselective embolization of the cavernous artery for HFP. Accessed April 20, 2021. Get useful, helpful and relevant health + wellness information. Pathophysiology Nine patients underwent selective embolization during arteriography, and in 1 patient, corporotomy and ligature of the cavernous artery were performed. The dorsal artery of the penis, the other terminal branch supplying the glans penis and prepuce. doi: 10.1136/bcr-2020-239534. In: Campbell-Walsh-Wein Urology. TURBT (Transurethral resection of the bladder), PRESS RELEASE: Alarmingly Low Awareness of Urology Across Europe. No etiologic causes were evident in the other patients. These cookies will be stored in your browser only with your consent. Copyright 2023 - European Association of Urology - All rights reserved, This information was last updated inMarch 2023. Posttraumatic high-flow priapism in children treated with autologous blood clot embolization: long-term results and review of the literature. Federal government websites often end in .gov or .mil. There are two types of priapism, ischemic (low-flow) and nonischemic (high-flow), and treatment varies depending on the type, its severity, and the underlying cause. Clinically, differentiation of low-flow from high-flow priapism is critical, because treatment for each is different. doi: 10.23750/abm.v91i10-S.10233. Priapism is a clinical diagnosis. This content does not have an English version. Because low-flow priapism can lead to permanent penile scarring that could impact a person's erectile function, it is important to seek immediate treatment for this condition. Ischemic priapism is comparable to a compartment syndrome causing hypoxia of the corpora cavernosa that is typically painful and requires emergent intervention to preserve erectile function. In some cases, the etiology remains unknown. ED may result from organic causes, psychological causes, or a combination of both. We do not endorse non-Cleveland Clinic products or services. Epub 2013 Dec 10. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Ther Adv Urol. The type of treatment you have for priapism will depend on whether you have low-flow or high-flow priapism. Patients may be followed by blood flow measurement by repeated PDU . Kuefer R, Bartsch G Jr, Herkommer K, et al. Gottsch H, Berger R, & Yang C. (2012). [Treatment using percutaneous arterial embolization of post-traumatic priapism in children]. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Doppler studies show normal or high velocities in cavernosal arteries. 2019 Apr;15(2):187.e1-187.e6. When nonsurgical treatment options are ineffective, or when damage has resulted, surgery may be required. Doppler studies show normal or high velocities in cavernosal arteries. Possible organic causes: vascular, neurogenic, hormonal, anatomic, drug-induced.12, A normal sexual erectile response results from the production of nitric oxide from endothelial cells after parasympathetic stimuli. Priapism. Your doctor will block the blood vessel that is causing the problem (artery embolisation). Sorry, there are no matching doctors in your area, Sorry no questions were found related to this procedure, When Your Prolonged Erection Turns into an Emergency: Signs Your Penis Is In Danger, Do Not Sell or Share My Personal Information. An official website of the United States government. Urology. If care is delayed, the penis may be scarred and could permanently lose erectile function (possibly erectile dysfunction). Elsevier; 2021. https://www.clinicalkey.com. Nonischemic priapism, or high-flow priapism, occurs when there's continuous blood flow to the erectile tissue, but the blood flow is unregulated and doesn't become properly stored inside the penis. This site needs JavaScript to work properly. The management is slightly different but follows the same principles for the sickle cell anemia variant of veno-occlusive priapism. Etiology During this test, a small needle is placed in the penis, some blood is drawn, and then it is sent to a lab for analysis. The Glickman Urological & Kidney Institute offers innovative treatments in urology and kidney medicine, including minimally invasive, scarless options for urologic procedures and medical management of kidney disease. However, the penile tissues continue to receive some blood flow and oxygen. Spontaneous resolution of delayed onset, posttraumatic high-flow priapism. You also have the option to opt-out of these cookies. The actual site of the arteriolacunar fistula can usually be accurately determined.3,4. ED may result from organic causes, psychological causes, or a combination of both. More common than high-flow version; Typically accompanied by significant pain due to ischemia (can be considered to be compartment syndrome of the penis) Common causes. Primary management of high-flow priapism consist of conservative treatments such as ice and site-specific compression atleast for initial 2-3 weeks. Transfemoral arteriography confirmed the arteriocavernous fistula which was successfully treated by selective embolisation of the internal . What the radiologist should know about the role of interventional radiology in urology. Dysregulation of vasorelaxing and vasoconstricting factors often results from injury, affecting nerve innervation and blood supply to the genitals. Mayo Clinic is a not-for-profit organization. Note: High-flow (non-ischemic) priapism will present with different signs/symptoms than low-flow priapism. There is unregulated blood flow in an arteriolacunar (not arteriovenous) fistula between one of the terminal branches of the internal pudendal artery (most commonly the cavernosal artery) and lacunar spaces of the corpora cavernosa. Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet. Advances in the understanding of priapism. This cookie is installed by Google Analytics. This is followed by irrigation with a sympathomimetic pharmaceutical agent and, if necessary, a surgical shunt. All rights reserved. Careers. Blood gases on blood aspirated from the corpora cavernosa revealed the presence of "high-flow" priapism. Prevalence increases with age: 12% are younger than 59 years, 22% are 60 to 69, and 30% are older than 69. The https:// ensures that you are connecting to the However, we believe early interventional radiology management with embolization of the fistula provides a better outcome for high-flow fistulas. Transl Androl Urol. Bookshelf Before Policy. If medication is necessary, is there a generic alternative? A medication, such as phenylephrine, might be injected into your penis. The cookie is used to store the user consent for the cookies in the category "Other. Although erectile function can improve after vascular reconstructive surgery or endovascular angioplasty of the internal pudendal/penile arteries,20-23 there is still very little evidence to recommend vascular imaging studies and therapies for ED in the general population. sharing sensitive information, make sure youre on a federal The cookies store information anonymously and assign a randomly generated number to identify unique visitors. Erectile Dysfunction Kuefer R, Bartsch G Jr, Herkommer K, et al. In: Ferri's Clinical Advisor 2021. and transmitted securely. Since nonischemic priapism often resolves without treatment, doctors typically take a watch-and-wait approach. Left untreated, blood vessels in the penis can rupture or the tissue can scar, leading to permanent erectile dysfunction. Urethral (spongiosal) artery supplying the corpora spongiosa and providing anastomoses with the dorsal artery of the penis at the glans penis Bethesda, MD 20894, Web Policies Mostly traumatic If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction. Nitric oxide causes smooth muscle relaxation, which leads to arterial influx of blood into the corpus cavernosum, followed by compression of venous return, producing an erection. 1 Approximately 74% of the priapism episodes are the stuttering (recurrent) However, we believe early interventional radiology management with embolization of the fistula provides a better outcome for high-flow fistulas. Priapism Treatment. Incidence Relevant Anatomy sharing sensitive information, make sure youre on a federal Conclusions: eCollection 2021 Mar. The https:// ensures that you are connecting to the Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. J Surg Case Rep. 2021 Mar 8;2021(3):rjab077. A longitudinal penile scan showed that the 16 G needle (arrow) was inserted into the penile abscess (Fig. Rigid penile shaft, but the tip of penis (glans) is soft. The causes of ischemic priapism are numerous and include various hemoglobinopathies, such as sickle cell disease and thalassemia, and any hypercoagulable state. High-flow priapism is a nonsexual, persistent erection caused by unregulated cavernous arterial inflow. High-flow priapism: An overview of diagnostic and therapeutic concepts We describe the case of a 23 year-old man with high-flow priapism following blunt perineal trauma. There is unregulated blood flow in an arteriolacunar (not arteriovenous) fistula between one of the terminal branches of the internal pudendal artery (most commonly the cavernosal artery) and lacunar spaces of the corpora cavernosa. The site is secure. Tibana TK, Fornazari VAV, Gutierrez Junior W, Marchiori E, Szejnfeld D, Nunes TF. The site is secure. The https:// ensures that you are connecting to the Generalized penile arterial insufficiency may result from stenotic arterial lesions of the internal pudendal arteries or from microangiopathy of the arteries of the corpora cavernosa. Venous Anatomy Advertising on our site helps support our mission. This branch most frequently replaces the dorsal artery of the penis and deep branches of the internal pudendal artery (with the internal pudendal artery terminating as the bulbar artery or with perineal branches). 2011 May;41(5):627-32. doi: 10.1007/s00247-010-1912-3. Any prothrombotic state There are two typeslow-flow/ischemic and high-flow/arterialand these are grouped based on the pathophysiology, with implications for subsequent treatment options and outcomes. Surgical and minimally invasive treatment of ischaemic and non-ischaemic priapism: a systematic review by the EAU Sexual and Reproductive Health Guidelines panel. Only gold members can continue reading. If the priapism is ischemic in nature, there are a number of treatment options, including aspiration, medication, and surgery. You might also need surgery to repair arteries or tissue damage resulting from an injury. and inject sympathomimetics as necessary. The treatment of priapism will differ depending on the diagnosis of these two different types. Arterial embolization in the treatment of post-traumatic priapism. The dorsal artery of the penis, the other terminal branch supplying the glans penis and prepuce. 1 F), then the 18 G needle was punctured into the abscess cavity through the core of the 16 G needle.Saline was pumped into the abscess cavity through the 18 G needle while the rinsing . Prevalence increases with age: 12% are younger than 59 years, 22% are 60 to 69, and 30% are older than 69.11 Splenic Embolization in Nontraumatized Patients, Image-Guided Interventions Expert Radiology Series. In high flow priapism's cases, high blood flow velocities were reported in the cavernosal arteries. American Urological Association guideline on the management of priapism. First-line treatment is aspiration that confirms the diagnosis and at the same time decompresses. Br J Radiol. Postoperatively, color Doppler ultrasonography revealed the absence of recurrence in 6 patients. ED affects up to one third of men throughout their lives and over 150 million men worldwide. doi: 10.1259/bjr/62360925. We'll assume you're ok with this, but you can opt-out if you wish. In contrast, nonischemic (high flow) priapism results from a trauma- related arterial injury. diagnosis and treatment of Priapism. We describe 4 cases of high flow arterial priapism, ranging from 1 week to 3 years in duration. 8600 Rockville Pike The onset is usually delayed after injury, but typically it is clinically evident within 72 hours.9 Aspiration of the cavernosa reveals arterial blood. We also use third-party cookies that help us analyze and understand how you use this website. De Magistris G, Pane F, Giurazza F, Corvino F, Coppola M, Borzelli A, Silvestre M, Amodio F, Cangiano G, Cavagli E, Niola R. Radiol Med. The bulbar and dorsal penile arteries are less frequently involved. Many of the drugs that have been developed to treat ED act at this level.13 This is necessary because the treatment for each is different, and treatment for ischemic priapism needs to happen as soon as possible. Cleveland Clinic is a non-profit academic medical center. As the pain persisted, he was assessed by urology staff on day 13. . https://www.merckmanuals.com/professional/genitourinary-disorders/symptoms-of-genitourinary-disorders/priapism#. Muneer A, et al. 2011 May;41(5):627-32. doi: 10.1007/s00247-010-1912-3. Ferri FF. Drugs Venous blood is evident on aspiration of the corpora cavernosa. Combination High Flow Priapism With Low Flow Priapism: CaseReport. A 21-year-old male with high-flow priapism after blunt perineal trauma. Only gold members can continue reading. The .gov means its official. Possible organic causes: vascular, neurogenic, hormonal, anatomic, drug-induced.