High-flow priapism is a rare condition mainly caused by perineal trauma. Laceration of cavernosal artery results in a formation of arterial-lacunar fistula with unregulated blood flow causing prolonged erection. We present a case of a 25-year-old man with high-flow priapism and concurrent erectile dysfunction treated with repeated selective embolisation with only a partial effect. When no further embolisation was possible, we assumed on conservative management even through the fistula was still present. Spontaneous detumescence occurred 9 months, and erectile function has fully restored 24 months after the injury. To the best of our knowledge, spontaneous detumescence with full restoration of erection even through the persistent arterial-lacunar fistula has not been reported previously. Therefore, we propose conservative approach after embolisation to be an option.
Keywords: arterial-lacunar fistula; conservative management; high-flow priapism; persistent fistula.
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