Update on genetic screening and treatment for infertile men with genetic disorders in the era of assisted reproductive technology / 대한생식의학회지

A genetic etiology of male infertility is identified in fewer than 25% of infertile men, while 30% of infertile men lack a clear etiology, resulting in a diagnosis of idiopathic male infertility. Advances in reproductive genetics have provided insights into the mechanisms of male infertility, and a characterization of the genetic basis of male infertility may have broad implications for understanding the causes of infertility and determining the prognosis, optimal treatment, and management of couples. In a substantial proportion of patients with azoospermia, known genetic factors contribute to male infertility. Additionally, the number of identified genetic anomalies in other etiologies of male infertility is growing through advances in whole-genome amplification and next-generation sequencing. In this review, we present an up-to-date overview of the indications for appropriate genetic tests, summarize the characteristics of chromosomal and genetic diseases, and discuss the treatment of couples with genetic infertility by microdissection-testicular sperm extraction, personalized hormone therapy, and in vitro fertilization with pre-implantation genetic testing.

Validation of SwimCount™, a Novel Home-Based Device That Detects Progressively Motile Spermatozoa: Correlation with World Health Organization 5th Semen Analysis

PURPOSE: We evaluated the usefulness of a home-based device (SwimCount™) compared with World Health Organization (WHO) 5th semen analysis in screening for male fertility in Asian men.MATERIALS AND METHODS: One hundred Asian men who visited CHA Seoul Station Fertility Center for evaluation of fertility were included. Semen samples were analyzed and compared with the SwimCount™ results. An aliquot of 0.5 mL of the semen sample was added to the SwimCount™ and a WHO 5th semen analysis was performed. Results were categorized as low (<5×10⁶/mL), and normal to high (≥5×10⁶/mL) total progressively motile sperm concentration. Receiver operating characteristic curve analysis was performed to evaluate the accuracy of the SwimCount™.RESULTS: The mean total progressively motile sperm concentration was 26.7×10⁶/mL. Semen analysis revealed that 28% of the samples were below the threshold count of 5 million/mL total progressively motile sperm concentration. The mean total progressively motile sperm concentration of the light color SwimCount™ result group determined by semen analysis was 7.5×10⁶/mL, and the mean total progressively motile sperm concentration of the moderate to dark color SwimCount™ result group was 34.2×10⁶/mL. An area under the receiver operating characteristic curve of 0.85 (95% confidence interval, 0.77–0.94; p<0.001) was obtained when the SwimCount™ was compared with semen analysis. The sensitivity and specificity were obtained at a cut off value of 5.0×10⁶/mL total progressively motile sperm concentration, giving a sensitivity and specificity of 87.5% and 73.4%.CONCLUSIONS: We confirmed the reliability of the SwimCount™ as a home-based device for male fertility by evaluating the total progressively motile sperm concentration.

Long-Term Experience of Sperm Cryopreservation in Cancer Patients in a Single Fertility Center

PURPOSE: Sperm cryopreservation before cancer treatment is the most effective method to preserve the fertility of male patients. We present our 21 years experience with sperm cryopreservation for cancer patients, including an examination of semen quality, the current status of cryopreserved sperm, and the rate of sperm use for assisted reproductive technology (ART). MATERIALS AND METHODS: A total of 721 cancer patients at Fertility Center of CHA Gangnam Medical Center successfully performed sperm cryopreservation for fertility preservation from January 1996 to December 2016. Medical chart review was used to analyze patient age, marital status, cancer type, semen volume, sperm counts and motility, length of storage, and current banking status. RESULTS: The major cancers of the 721 patients were leukemia (28.4%), lymphoma (18.3%), testis cancer (10.0%). The mean age at cryopreservation was 27.0 years, and 111 patients (15.4%) performed sperm cryopreservation during or after cancer treatment. The mean sperm concentration was 66.7±66.3 ×106/mL and the mean sperm motility was 33.8%±16.3%. During median follow-up duration of 75 months (range, 1–226 months), 44 patients (6.1%) used their banked sperm at our fertility center for ART and 9 patients (1.2%) transferred their banked sperm to another center. The median duration from cryopreservation to use was 51 months (range, 1–158 months). CONCLUSIONS: Sperm cryopreservation before gonadotoxic treatment is the most reliable method to preserve the fertility of male cancer patients. Sperm cryopreservation should be offered as a standard of care for all men planning cancer therapy.

Anti-oxidative Effect of Piperine from Piper nigrum L. in Caenorhabditis elegans

Piper nigrum L. (Piperaceae), which is a well-known food seasoning, has been used as a traditional medicine for the treatment of vomiting, abdominal pain, diarrhea and anorexia in Korea, China and Japan. Methanol extract from the fruit of P. nigrum was successively partitioned as n-hexane, methylene chloride, ethyl acetate, n-butanol and H₂O soluble fractions. Among those fractions the ethyl acetate soluble fraction showed the most potent DPPH radical scavenging activity, and piperine was isolated from the ethyl acetate fraction. To know the antioxidant activity of piperine, we tested the activities of superoxide dismutase (SOD) and catalase together with oxidative stress tolerance and intracellular ROS level in Caenorhabditis elegans. To investigate whether piperine-mediated increased stress tolerance was due to regulation of stress-response gene, we quantified SOD-3 expression using transgenic strain including CF1553. Consequently, piperine enhanced SOD and catalase activities of C. elegans, and reduced intracellular ROS accumulation in a dose–dependent manner. Moreover, piperine-treated CF1553 worms exhibited significantly higher SOD-3::GFP intensity.

Risk of complications and urinary incontinence following cytoreductive prostatectomy: A multi-institutional study / 亚洲男科学杂志(英文版)

Emerging evidence has suggested that cytoreductive prostatectomy (CRP) allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer (mPCa) has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer (PCa). Urinary incontinence was defined as the use of any pad. CRP had longer operative times (200 min vs 140 min, P < 0.0001) and higher estimated blood loss (250 ml vs 125 ml, P < 0.0001) compared to the control group. However, both overall (8.82% vs 5.85%) and major complication rates (4.41% vs 2.17%) were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group (57.4% vs 90.8%, P < 0.0001). Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model (OR: 1.18; 95% CI: 1.02-1.37; P = 0.025) and surgery type-adjusted model (OR: 1.17; 95% CI: 1.01-1.36; P = 0.034). In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.

Longevity and Stress Resistant Property of 6-Gingerol from Zingiber officinale Roscoe in Caenorhabditis elegans

In order to discover lifespan-extending compounds made from natural resources, activity-guided fractionation of Zingiber officinale Roscoe (Zingiberaceae) ethanol extract was performed using the Caenorhabditis elegans (C. elegans) model system. The compound 6-gingerol was isolated from the most active ethyl acetate soluble fraction, and showed potent longevity-promoting activity. It also elevated the survival rate of worms against stressful environment including thermal, osmotic, and oxidative conditions. Additionally, 6-gingerol elevated the antioxidant enzyme activities of C. elegans, and showed a dose-depend reduction of intracellular reactive oxygen species (ROS) accumulation in worms. Further studies demonstrated that the increased stress tolerance of 6-gingerol-mediated worms could result from the promotion of stress resistance proteins such as heat shock protein (HSP-16.2) and superoxide dismutase (SOD-3). The lipofuscin levels in 6-gingerol treated intestinal worms were decreased in comparison to the control group. No significant 6-gingerol-related changes, including growth, food intake, reproduction, and movement were noted. These results suggest that 6-gingerol exerted longevity-promoting activities independently of these factors and could extend the human lifespan.

Association of Nutrient Intakes with Cognitive Function in Koreans Aged 50 years and Older

This study attempted to investigate whether nutrient and food intake were related with mild cognitive impairment (MCI) in adults and elderly over 50 years of age in Korea. Questionnaires and anthropometric measurements were conducted on general aspects of the research, and food frequency questionnaires (FFQs) were conducted to determine nutritional status. The relative theta power (RTP) through electroencephalography (EEG) measurements, neurocognitive function test (NFT; CNS Vital Signs), and cognitive function was measured. The MCI group consumed significantly lower C18:4, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) among the N-3 fatty acids, N-6 fatty acids dihomo-γ-linolenic acid (DGLA), mono unsaturated fatty acids, C22:1, biotin, vitamin D in the nutrients, and sweet potato (12.35g/day, p = 0.015), mackerel (3.38g/day, p = 0.017), mandarin orange (p = 0.016), persimmon (p = 0.013) and apple (p = 0.023) in the food than the normal group did. And the MCI group consumed salted fish (3.14g/day, p = 0.041) and ice-cream (5.01g/day, p = 0.050) at a significantly higher level. Delayed verbal score, delayed visual score, and verbal memory score of the NFT and RTP values of the prefrontal cortex among the EEGs were significantly lower in the MCI group compared to those in the normal group. From this study, we found that nutrient and food intake are closely related to MCI in Korean aged 50 years and older, but more human studies are needed to verify these findings.

The role of vasoepididymostomy for treatment of obstructive azoospermia in the era of in vitro fertilization: a systematic review and meta-analysis / 亚洲男科学杂志(英文版)

This study comprises a systematic review and meta-analysis of microsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia. A comprehensive literature search was performed using Medline, Embase, and the Cochrane library that included all studies related to microsurgical vasoepididymostomy. Keywords included "vasoepididymostomy," "epididymovasostomy," "epididymal obstruction," and "epididymis obstruction." Event rate and risk ratio (RR) were estimated. Patency rate and pregnancy rate were investigated. The analysis comprised 1422 articles, including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017. The overall mean patency rate was 64.1% (95% confidence interval [CI]: 58.5%-69.3%; I2=83.0%), and the overall mean pregnancy rate was 31.1% (95% CI: 26.9%-35.7%; I2=73.0%). We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38% (95% CI: 1.21%-1.57%; P < 0.00001). A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR = 1.17%; 95% CI: 1.01%-1.35%; P = 0.04). Patients with motile sperm in epididymal fluid exhibited an RR of 1.53% (95% CI: 1.11%-2.13%; P = 0.01) with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally, anastomosing a larger caudal area, and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.

Risk of complications and urinary incontinence following cytoreductive prostatectomy: a multi-institutional study / 亚洲男科学杂志(英文版)

Emerging evidence has suggested that cytoreductive prostatectomy (CRP) allows superior oncologic control when compared to current standard of care androgen deprivation therapy alone. However, the safety and benefit of cytoreduction in metastatic prostate cancer (mPCa) has not been proven. Therefore, we evaluated the incidence of complications following CRP in men newly diagnosed with mPCa. A total of 68 patients who underwent CRP from 2006 to 2014 at four tertiary surgical centers were compared to 598 men who underwent radical prostatectomy for clinically localized prostate cancer (PCa). Urinary incontinence was defined as the use of any pad. CRP had longer operative times (200 min vs 140 min, P < 0.0001) and higher estimated blood loss (250 ml vs 125 ml, P < 0.0001) compared to the control group. However, both overall (8.82% vs 5.85%) and major complication rates (4.41% vs 2.17%) were comparable between the two groups. Importantly, urinary incontinence rate at 1-year after surgery was significantly higher in the CRP group (57.4% vs 90.8%, P < 0.0001). Univariate logistic analysis showed that the estimated blood loss was the only independent predictor of perioperative complications both in the unadjusted model (OR: 1.18; 95% CI: 1.02-1.37; P = 0.025) and surgery type-adjusted model (OR: 1.17; 95% CI: 1.01-1.36; P = 0.034). In conclusion, CRP is more challenging than radical prostatectomy and associated with a notably higher incidence of urinary incontinence. Nevertheless, CRP is a technically feasible and safe surgery for selecting PCa patients who present with node-positive or bony metastasis when performed by experienced surgeons. A prospective, multi-institutional clinical trial is currently underway to verify this concept.

Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis

PURPOSE: To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer. MATERIALS AND METHODS: Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies. RESULTS: A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up. CONCLUSION: RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP.

Lifespan Extending and Stress Resistant Properties of Vitexin from Vigna angularis in Caenorhabditis elegans

Several theories emphasize that aging is closely related to oxidative stress and disease. The formation of excess ROS can lead to DNA damage and the acceleration of aging. Vigna angularis is one of the important medicinal plants in Korea. We isolated vitexin from V. angularis and elucidated the lifespan-extending effect of vitexin using the Caenorhabditis elegans model system. Vitexin showed potent lifespan extensive activity and it elevated the survival rates of nematodes against the stressful environments including heat and oxidative conditions. In addition, our results showed that vitexin was able to elevate antioxidant enzyme activities of worms and reduce intracellular ROS accumulation in a dose-dependent manner. These studies demonstrated that the increased stress tolerance of vitexin-mediated nematode could be attributed to increased expressions of stress resistance proteins such as superoxide dismutase (SOD-3) and heat shock protein (HSP-16.2). In this work, we also studied whether vitexin-mediated longevity activity was associated with aging-related factors such as progeny, food intake, growth and movement. The data revealed that these factors were not affected by vitexin treatment except movement. Vitexin treatment improved the body movement of aged nematode, suggesting vitexin affects healthspan as well as lifespan of nematode. These results suggest that vitexin might be a probable candidate which could extend the human lifespan.

Supporting evidence for robotic urological surgery

No abstract available.

Genistein from Vigna angularis Extends Lifespan in Caenorhabditis elegans

The seed of Vigna angularis has long been cultivated as a food or a folk medicine in East Asia. Genistein (4',5,7-trihydroxyisoflavone), a dietary phytoestrogen present in this plant, has been known to possess various biological properties. In this study, we investigated the possible lifespan-extending effects of genistein using Caenorhabditis elegans model system. We found that the lifespan of nematode was significantly prolonged in the presence of genistein under normal culture condition. In addition, genistein elevated the survival rate of nematode against stressful environment including heat and oxidative conditions. Further studies demonstrated that genistein-mediated increased stress tolerance of nematode could be attributed to enhanced expressions of stress resistance proteins such as superoxide dismutase (SOD-3) and heat shock protein (HSP-16.2). Moreover, we failed to find genistein-induced significant change in aging-related factors including reproduction, food intake, and growth, indicating genistein exerts longevity activity independent of affecting these factors. Genistein treatment also led to an up-regulation of locomotory ability of aged nematode, suggesting genistein affects healthspan as well as lifespan of nematode. Our results represent that genistein has beneficial effects on the lifespan of C. elegans under both of normal and stress condition via elevating expressions of stress resistance proteins.

Robot-Assisted Laparoendoscopic Single-Site Partial Nephrectomy With the Novel Da Vinci Single-Site Platform: Initial Experience

PURPOSE: To report our initial clinical cases of robotic laparoendoscopic single-site (R-LESS) partial nephrectomy (PN) performed with the use of the novel Da Vinci R-LESS platform. MATERIALS AND METHODS: Three patients underwent R-LESS PN from November 2013 through February 2014. Perioperative and postoperative outcomes were collected and intraoperative difficulties were noted. RESULTS: Operative time and estimated blood loss volume ranged between 100 and 110 minutes and between 50 and 500 mL, respectively. None of the patients was transfused. All cases were completed with the off-clamp technique, whereas one case required conversion to the conventional (multiport) approach because of difficulty in creating the appropriate scope for safe tumor resection. No major postoperative complications occurred, and all tumors were resected in safe margins. Length of hospital stay ranged between 3 and 7 days. The lack of EndoWrist movements, the external collisions, and the bed assistant's limited working space were noticed to be the main drawbacks of this surgical method. CONCLUSIONS: Our initial experience with R-LESS PN with the novel Da Vinci platform shows that even though the procedure is feasible, it should be applied in only appropriately selected patients. However, further improvement is needed to overcome the existing limitations.

The Longevity Properties of 1,2,3,4,6-Penta-O-Galloyl-beta-D-Glucose from Curcuma longa in Caenorhabditis elegans

Here in this study, we isolated 1,2,3,4,6-penta-O-galloyl-beta-D-glucose (PGG) from Curcuma longa L. and elucidated the lifespanextending effect of PGG using Caenorhabditis elegans model system. In the present study, PGG demonstrated potent lifespan extension of worms under normal culture condition. Then, we determined the protective effects of PGG on the stress conditions such as thermal and oxidative stress. In the case of heat stress, PGG-treated worms exhibited enhanced survival rate, compared to control worms. In addition, PGG-fed worms lived longer than control worms under oxidative stress induced by paraquat. To verify the possible mechanism of PGG-mediated increased lifespan and stress resistance of worms, we investigated whether PGG might alter superoxide dismutase (SOD) activities and intracellular ROS levels. Our results showed that PGG was able to elevate SOD activities of worms and reduce intracellular ROS accumulation in a dose-dependent manner.

The Role of TURP in the Detection of Prostate Cancer in BPH Patients with Previously Negative Prostate Biopsy

PURPOSE: We aimed to investigate the significance of early detection of transition zone prostate cancer by transurethral resection of prostate (TURP) in benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) in whom prostate cancer was suspected despite a negative transrectal ultrasonography (TRUS) biopsy result. MATERIALS AND METHODS: From January 2006 to January 2009, a total of 165 patients who underwent TURP were evaluated. The prostate cancer detection rate was compared between patients who underwent TRUS biopsy before TURP (group A) and those who did not (group B). All charts were evaluated retrospectively, including prostate-specific antigen (PSA), digital rectal examination (DRE), TURP results (including resection volume and pathology report), TRUS, and TRUS biopsy results. Group A was subdivided into group A1, who were diagnosed with prostate cancer after TURP, and group A2, who were diagnosed with BPH after TURP. RESULTS: The cancer detection rate showed no significant difference between groups A and B (8.9% vs. 7.5%, p>0.05). The mean PSA levels in groups A1 and A2 were 15.5+/-14.0 ng/ml and 9.1+/-5.1 ng/ml, respectively (p>0.05). In group A1, 40% had an abnormal DRE, compared with 6.7% in group A2 (p<0.05). After TURP, the mean percentage of resected prostatic chips of the prostate cancer group and BPH group were 33.9% and 18.6%, respectively (p=0.001). A positive correlation was found between the detection rate of prostate cancer and PSA (p=0.01). CONCLUSIONS: BPH patients in whom prostate cancer is suspected and who have lower urinary tract symptoms (LUTS) with a previously negative TRUS biopsy result can undergo TURP, which results in immediate improvement in bladder outlet obstruction and early diagnosis of clinically significant transition zone prostate cancer.

Initial Experience with Robotic-Assisted Laparoscopic Partial Cystectomy in Urachal Diseases

PURPOSE: In this study, we report our initial experience with robot-assisted laparoscopic partial cystectomy (RLPC) in urachal diseases. MATERIALS AND METHODS: Two men and two women with a mean age of 51.5+/-9.3 years underwent RLPC between June 2009 and December 2009. In each case, a single surgeon using the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) used a transperitoneal approach with a 0 degrees robotic camera. After careful observation of the intravesical portion of the mass, the mass was excised by use of monopolar scissors circumferentially. The bladder was closed in two layers with watertight running sutures made with 2-0 Vicryl. RESULTS: The mean operative time was 198 minutes (range, 130-260 minutes), the mean console time was 111 minutes (range, 70-150 minutes), and the mean estimated blood loss was 155 ml. The urethral catheter was removed on postoperative day 7 after a normal cystogram, and the surgical drain was removed on postoperative day 2.5 (range, 2-3 days). The mean hospital stay was 6 days (range, 4-7 days). There were no major complications. The pathology report revealed that one patient had a urachal cystadenoma, two patients had a urachal cyst, and one patient had a patent urachus. CONCLUSIONS: Our initial experience with RLPC for benign urachal disease is that it is a safe and feasible treatment modality. However, more cases are required to confirm the efficacy of RLPC.

Hexane-Soluble Fraction of the Common Fig, Ficus carica, Inhibits Osteoclast Differentiation in Murine Bone Marrow-Derived Macrophages and RAW 264.7 Cells

Osteoclasts, derived from multipotent myeloid progenitor cells, play homeostatic roles in skeletal modeling and remodeling, but may also destroy bone in pathological conditions such as osteoporosis and rheumatoid arthritis. Osteoclast development depends critically on a differentiation factor, the receptor activator of NF-kappaB ligand (RANKL). In this study, we found that the hexane soluble fraction of the common fig Ficus carica (HF6-FC) is a potent inhibitor of osteoclastogenesis in RANKL-stimulated RAW264.7 cells and in bone marrow-derived macrophages (BMMs). HF6-FC exerts its inhibitory effects by suppression of p38 and NF-kappaB but activation of ERK. In addition, HF6-FC significantly decreased the expression of NFATc1 and c-Fos, the master regulator of osteoclast differentiation. The data indicate that components of HF6-FC may have therapeutic effects on bone-destructive processes such as osteoporosis, rheumatoid arthritis, and periodontal bone resorption.

High-flow Priapism in a Child After Perineal Trauma / 대한남성과학회지

High flow priapism is a prolonged, non-painful penile erection unrelated to sexual stimulation after penile or perineal trauma. We report a case of high-flow priapism treated successfully with superselective embolization. An 8-year-old boy presented to our hospital 9 days after having been struck in the perineum during a bicycle accident. After the injury, the patient suffered a painless prolonged erection. High flow priapism was diagnosed by cavernosal blood gas analysis and penile duplex doppler ultrasonography. We identified the position of the fistula and pseudoaneurysm with angiography and embolized the lesions super-selectively with an autologous blood clot, gel foam, and a microcoil, bilaterally. After 2 superselective embolizations, the patient had detumescence. This case shows that bilateral arterio-cavernosal fistulas can be successfully treated with superselective arterial embolization.

High-flow Priapism in a Child After Perineal Trauma / 대한남성과학회지

High flow priapism is a prolonged, non-painful penile erection unrelated to sexual stimulation after penile or perineal trauma. We report a case of high-flow priapism treated successfully with superselective embolization. An 8-year-old boy presented to our hospital 9 days after having been struck in the perineum during a bicycle accident. After the injury, the patient suffered a painless prolonged erection. High flow priapism was diagnosed by cavernosal blood gas analysis and penile duplex doppler ultrasonography. We identified the position of the fistula and pseudoaneurysm with angiography and embolized the lesions super-selectively with an autologous blood clot, gel foam, and a microcoil, bilaterally. After 2 superselective embolizations, the patient had detumescence. This case shows that bilateral arterio-cavernosal fistulas can be successfully treated with superselective arterial embolization.