Pudendal Artery Fistula Treatment

A pudendal artery fistula is a hole that opens between the pudendal artery and surrounding blood vessels, causing priapism (an erection that doesn't go away) or erectile dysfunction (the inability to achieve or sustain an erection). The pudendal artery supplies blood from the femoral artery to the external genitals, and interruption of blood flow through it can cause problems with normal sexual and urinary functions. The good news is that a pudendal artery fistula can be treated.

Indications

• Your doctor may suspect a pudendal artery fistula if you complain of priapism or erectiule dysfunction but do not exhibit any of the typical high-risk characteristics: advanced age, hypertension (high blood pressure), diabetes, smoking and obesity, for example. If your child develops priapism, this is one possible cause.

Diagnosis

• After an office examination, your doctor may refer you to a urologist, who will probably recommend a sonogram (ultrasound), a test that uses sound waves to create a picture of your internal organs. This test may reveal tell-tale signs of a pudendal artery fistula.

Pinpointing the Problem

• After a positive sonogram, your urologist's next diagnostic step will most likely be to order an angiogram, a test that creates a real-time image of your blood vessels. This is done under sedation and regional anesthesia. It involves a tiny guide wire followed by a slender catheter (tube) being inserted into the area where the suspect blood vessels are, through a small nick in the femoral artery in your thigh. The angiogram allows the urologist to see exactly where the fistula is located and to determine what kind of treatment is best.

Treatment

• The only way to treat a pudendal artery fistula is through embolization. Using angiogram to guide his instruments, your urologist will insert material designed to close (occlude) the offending hole, such as a special absorbent sponge, or tiny platinum coils. It may take more than one procedure, but doctors report in the American Journal of Radiology and in the British Journal of Radiology that the result is usually restored normal function of the penis--the normal ability to achieve and sustain an erection that then subsides.

Women

• Pudendal artery fistula is uncommon in women, whose pudendal artery is a much smaller blood vessel than in men, but if you develop similar sexual dysfunction, it's still important to see a gynecologist or a urologist, as there may be other blood-flow problems.