Clinical features:
(1) The patient has a history of trauma to the perineum (blunt trauma, gunshot wound, penetrating injury, surgery, etc).
(2) The penis has become persistently engorged and partially to totally erect.
(3) Doppler ultrasonography shows increased blood flow through the cavernosal artery.
(4) Blood aspirated from the corpora cavernosa shows a high PaO2.
(5) Irrigation of the corpora cavernosa with 1:100,000 solution of epinephrine in normal saline results in detumescence, with engorgement returning as soon as the irrigation is stopped.
(6) A cavernosogram shows uniform filling of the vessels without occlusion or filling defect.
(7) Selective pudendal arteriography (transfemoral pelvic arteriography with selection of the internal pudendal arteries) will demonstrate the arteriocavernosal fistula.
The preferred method of treating the fistula in percutaneous embolization, although surgery may be performed.
