A rare case of suspected perineal nodular induration

Floyd, Michael S.; Omar, Ahmed M.; Khattak, Altaf Q.

doi:10.5489/cuaj.4716

Cited by 3 publications

(11 citation statements)

References 5 publications

(8 reference statements)

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“…Perineal nodular induration, also known as ischiatic hygroma [ 4 , 9 , 10 ], is a pseudoneoplastic lesion caused by repetitive microtrauma from friction and vibration between the saddle and ischial tuberosities with shearing of the superficial perineal fascia [ 3 , 4 , 10 ]. Although the exact pathophysiology is debated [ 7 ], chronic lymphoedema and resultant fibrous tissue is a proposed mechanism [ 5 , 11 ]. In men, PNI develops as a mass next to the median raphe, posterior to the scrotum [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…European clinicians may be more aware of this condition [ 4 , 7 , 14 ] due to the established cycling culture compared to North American countries. Furthermore, there is potential for misdiagnosis in females [ 5 ] as the vulvar region can develop a wide range of mesenchymal lesions [ 5 , 11 ]. PNI has been mistaken for lipoma [ 6 , 8 ], and has even been referred to a specialty sarcoma center for concern of a growing paratesticular mass [ 6 ] which led to serial MRIs and biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…Although this case is in a female, PNI must be considered in both sexes. A starting differential for similar lesions includes lymphadenopathy, hydocoeles/varicocoeles, epidermal/sebaceous cysts, aneurysms, urethral pathologies/ syringocoele, and hernias [ 3 , 5 , 6 , 8 , 11 , 14 ]. Localized lymphoedema and vulvar hypertrophy can occur in females.…”

Section: Discussionmentioning

confidence: 99%

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“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

Norman

Vitale

2020

International Journal of Surgery Case Reports

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Highlights PNI is a pseudoneoplastic lesion caused by repetitive microtrauma. Shearing in perineal fascia stimulates fibroblastic proliferation. Reported almost exclusively in males, it can occur in females and is underdiagnosed. Cyclists and any saddle sport athletes (even seated lawnmowing) are at risk. Treatment is to remove the trigger; surgery can be considered in refractory cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

Norman

Vitale

2020

International Journal of Surgery Case Reports

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“…The authors should acknowledge that specific to male health, cycling has been implicated in the development of a benign condition called perineal nodular induration. 2 This is a pseudotumour also known as biker’s nodule, accessory testicle or ischiatic hygroma. 3 It usually develops in the perineum, posterior to the scrotum, and may present as a single midline mass, a lateral mass located over the ischial tuberosities or as a dual mass either side of the midline raphe.…”

mentioning

confidence: 99%

“…Treatment includes saddle adjustment, intra-lesional steroids or excision. 2 Case reports exist of conservative management. 4…”

mentioning

confidence: 99%

Re: Koupparis et al. Cycling and men’s health – A worldwide survey in association the Global Cycling Network, J Clin Urol 2020

Pina

Floyd

Khattak

et al. 2020

Journal of Clinical Urology

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Getting to the Bottom of Saddle Sores: A Scoping Review of the Definition, Prevalence, Management and Prevention of Saddle Sores in Cycling

Napier

Heron

2022

IJERPH

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Objectives: To summarise and map the existing evidence relating to the definition, prevalence, prevention and management of saddle sores within the literature and highlight research gaps. Design: Scoping review. Data Sources: Three databases were searched using an appropriate search strategy agreed on by the authors with the aid of an experienced medical librarian; these databases were MEDLINE, EMBASE and Web of Science. Eligibility Criteria: To be included in this review, studies must have made specific reference to dermatological conditions that affect the saddle area, specifically arising from cycling, in either sex. Results: Seventeen studies were selected for inclusion. Saddle sores in males were the focus of thirteen studies, with only two reporting in females. Saddle sores were defined as connective tissue lesions affecting the skin in the saddle area, which can be both acute and chronic. Commonly cited preventions were chamois cream, high quality, well-fitting cycling equipment and good personal hygiene. Management in the early stages usually involves rest. Topical and intralesional steroids and lubricating creams are recommended treatments for small saddle sores, with surgical excision an option for larger, persistent saddle sores. However, surgery and steroid use may increase risk of recurrence. Conclusions: Saddle sores are an underrepresented, male-dominated issue within the literature. There is particularly limited evidence around treatment options, including topical steroids and surgical removal. Further well-designed observational studies and/or randomised controlled trials will help provide further evidence on prevalence, prevention and treatment available in the future.

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A rare case of suspected perineal nodular induration

Cited by 3 publications

References 5 publications

“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

Re: Koupparis et al. Cycling and men’s health – A worldwide survey in association the Global Cycling Network, J Clin Urol 2020

Getting to the Bottom of Saddle Sores: A Scoping Review of the Definition, Prevalence, Management and Prevention of Saddle Sores in Cycling

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