(081) Superselective Transcatheter Embolization in High-Flow Priapism: Long-Term Erectile Function Outcomes from a Multicenter Analysis

Introduction High-flow priapism (HFP) is a rare urological condition, often secondary to genitoperineal trauma, resulting in arterio-cavernosal fistulas. Superselective arterial embolization is the preferred treatment when conservative management fails, but long-term data on erectile function (EF) outcomes remain limited. Objective To evaluate long-term erectile function outcomes in patients with HFP undergoing embolization and to identify predictors of EF impairment at follow-up. Methods Data from 41 patients with HFP admitted to six tertiary referral centers (2002 – 2024) were analyzed. Diagnosis was confirmed using penile Doppler ultrasound, blood gas analysis, and selective pudendal arteriography. Embolization was performed using absorbable or non-absorbable agents. EF was evaluated pre- and post-embolization using the IIEF-5 and the EHS questionnaires. Logistic and linear regression models were used to assess predictors of EF at follow-up. Results Median (IQR) age was 35 (27-44) years, and the pre-embolization IIEF-5 was 25 (24–25). Non-absorbable embolic agents were used in 35 (85.4%) patients. Median follow-up was 44 (12–80) months. At follow-up, the median IIEF-5 score was 21 (18–24), with a median decrease of -4 (-6 - -1) points from baseline. Severe ED occurred in only 2.4% of patients; however, 46.3% had assisted EF (PDE5i, nutraceuticals, Li-SWT or vacuum devices). Patients with assisted EF at follow up had higher baseline Charlson Comorbidity Index (CCI) and lower IIEF-5 scores than those with unassisted EF (all p<0.03). Lower CCI, and higher baseline IIEF-emerged as predictors of IIEF-5 scores at follow-up, after accounting for age. Higher CCI was the only predictor of assisted EF at follow-up. No significant associations were found with embolization technique and EF. Conclusions Superselective embolization for HFP is highly effective with limited impact on EF at long term. Nonetheless, nearly half of patients required assisted EF at follow-up, with comorbidities and lower baseline EF as significant predictors. Long-term monitoring and individualized counseling are essential. Disclosure No