Finally an arteriogram of the pudendal arterial system was done, and this identified the point of the fistula. A small coil of material was placed into the damaged artery and prevented the erection. The patient eventually recovered and is currently able to get normal erections. The caveat in this case is that it is extremely important to have an actual accurate diagnosis when treating this disease. Irrigations with drugs and shunts would have been hopeless in this situation and would have made the patient worse off.
Timing is the most important issue with priapism.
Treatment must be performed on the ischemic priapism as soon as possible to prevent permanent damage. Tight dressings after the procedure may also result in damage to the skin and loss of tissue. It is extremely important to have the physician get an informed consent and to be absolutely sure that the patient understands that at least 50 percent of men who develop priapism will have some degree of erection problems, regardless of the duration or method of management used to treat this condition. Complications can and do occur during and after the treatment for priapism. Infection is so common that all patients with priapism should be placed on antibiotics.