Quantitative functional outcomes of the conservative management of partial segmental thrombosis of the corpus cavernosum

Abstract

The low incidence of partial segmental thrombosis of the corpus cavernosum (PSTCC) means its management is guided by isolated case reports. Erectile function is an important outcome that has not been described quantitatively in the literature. We present two cases of PSTCC managed conservatively. Although both patients reported resolution of local symptoms, formal analysis of sexual function at follow-up review has revealed that only one achieved complete recovery. Partial segmental thrombosis of the corpus cavernosum (PSTCC) is a rare condition with no reported UK cases and only 35 described in the world literature to date.1 The optimal management strategy of PSTCC remains elusive; both surgical and non-surgical approaches have been reported. We describe two conservatively managed cases of PSTCC and detail their formal erectile function at follow-up review, measured using the validated five-item version of the International Index of Erectile Function (IIEF-5) questionnaire. 2 Case histories Case AA 19-year-old moped user presented with a 3-day history of a painful perineal mass and no lower urinary tract symptoms, prior erectile dysfunction or priapism. He had engaged in vigorous sexual activity the night before the appearance of the mass and admitted misuse of anabolic steroids.Examination revealed a tender swelling over the proximal left corpus cavernosum with a flaccid distal penis. Admission blood tests and urinalysis were unremarkable apart from elevation of C-reactive protein at 91mg/l. Further investigation revealed hypogonadotrophic hypogonadism (low testosterone, normal luteinising hormone and follicle stimulating hormone) secondary to anabolic steroid misuse. Subsequent magnetic resonance imaging (MRI) showed thrombosis of the perineal part of the corpus cavernosum (Figure 1).The patient was managed conservatively (analgesia, 1 month of daily low molecular weight heparin [LMWH] injections and 3 months of aspirin 75mg daily). Repeat MRI at six weeks (Figure 1) showed significantly reduced thrombus volume. He subsequently reported resolution of the tender mass. However, detailed assessment using the IIEF-5 questionnaire revealed mild erectile dysfunction at 17 weeks and mild/moderate erectile dysfunction at 30 weeks (Table 1). He reported no penile curvature as the result of PSTCC. Case BA 37-year-old without any prior erectile dysfunction presented with perineal pain and dysuria. He had had vigorous sexual intercourse the preceding day, having just returned home after a two-hour flight from a long cycling holiday. Examination revealed a tender mass in the perineum arising from the left corpus cavernosum with a distal flaccid penis. Blood tests were unremarkable. Urinalysis was negative. Pelvic radiography and Doppler ultrasonography of the scrotum, inguinal and perineal region detected no abnormality. He underwent MRI, which showed low signal intensity in the base of the left corpus cavernosum, in keeping with PSTCC (Figure 2).At the six-week follow-up review, the patient reported resoluti...

Case report. Het herkennen en behandelen van een idiopathische partiële trombose van het corpus cavernosum, een zeldzaam en wellicht onbekend fenomeen in de acute urologie

“…Toch lijkt het ontstaan meestal idiopathisch [1][2][3][4][5][6][7][8][9][10][11]. Wel verdient het aanbeveling om hematologische tests te verrichten of de patiënt voor dergelijke tests door te verwijzen naar de hematoloog.…”

“…Uit de literatuur komt naar voren dat de typische klachten waarmee een patiënt zich presenteert, bestaan uit hevige perineale pijnklachten en erectiestoornissen [3,4,6,14]. Ook wordt in sommige gevallen dysurie en een zwakkere urinestraal omschreven [6].…”

“…Andere, meer zeldzame oorzaken van de hier beschreven klachten zijn primaire tumoren, bijvoorbeeld lymfomen of sarcomen [3].…”

“…Daarnaast is duplexechografie kosteneffectief en geschikt voor patiënten met een contrastallergie [5]. De kanttekening die hierbij moet worden geplaatst, is dat niet bij alle patiënten die in de literatuur worden beschreven, de trombose middels echo kon worden vastgesteld [3]. Om de diagnose dus daadwerkelijk te bevestigen, lijkt een MRI-scan de gouden standaard.…”

“…Op den duur lijkt de erectiele functie te verbeteren. Ook reageert de verminderde erectiele toestand goed op PDE5-remmers [3].…”