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Rybár Ľ, Hesko P, Kollárik B, Andrisová J. Partial segmental thrombosis of the corpus cavernosum post prolonged run and MRI changes during follow-up: A case report. Urol Case Rep 2023; 51:102615. [PMID: 38046257 PMCID: PMC10689872 DOI: 10.1016/j.eucr.2023.102615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/05/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
Partial segmental thrombosis of the corpus cavernosum (PSTCC) is a rare condition predominantly occurring in young men. We report a case of a 44-year-old man presenting with a spontaneous painful mass in the right proximal cavernous corpus (CC) one day following a prolonged run. An ultrasonography and MRI identified a thrombus in the CC. Anticoagulants and analgesics were prescribed, a non-surgical approach was chosen. Symptoms disappeared in a week as apparent by a reduction of thrombus on the MRI. Three years later, a residual thrombus with fibrosis was detected. Patient continues to be asymptomatic at the time of follow-up.
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Affiliation(s)
- Ľuboš Rybár
- Department of Urology, Bory Hospital, Ivana Kadlečíka 2, Lamač, 841 03, Bratislava, Slovakia
| | - Patrik Hesko
- Department of Urology, Bory Hospital, Ivana Kadlečíka 2, Lamač, 841 03, Bratislava, Slovakia
| | - Boris Kollárik
- Department of Urology, Bory Hospital, Ivana Kadlečíka 2, Lamač, 841 03, Bratislava, Slovakia
| | - Jana Andrisová
- Radiologia s.r.o., St. Cyril and Methodius Hospital, University Hospital in Bratislava, Antolská 11, 851 07, Bratislava, Slovakia
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2
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Schneider J, Schöttle T, Randecker D, Schwaibold H. [Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) : A rare urological emergency]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:929-935. [PMID: 37142812 DOI: 10.1007/s00120-023-02082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Idiopathic partial thrombosis of the corpus cavernosum (IPTCC) is a rare, semi-acute disease in young, healthy men. In addition to an anatomical predisposition, perineal microtrauma is stated as the main risk factor. MATERIALS AND METHODS A case report and the results of a literature search with descriptive-statistical processing of 57 peer-reviewed publications are presented. A therapy concept was drawn up for clinical practice. RESULTS Our patient was treated conservatively and was consistent with the 87 cases which have been published since 1976. IPTCC is a disease of young men (33.2 years, range 18-70), which is associated with pain and perineal swelling in 88%. Sonography and contrast-enhanced magnetic resonance imaging (MRI) proved to be the diagnostic modality of choice, demonstrating the thrombus and in 89% a connective tissue membrane inside the corpus cavernosum. Treatment included antithrombotic and analgesic (n = 54, 62.1%), surgical (n = 20, 23%), analgesic (n = 8, 9.2%), via injection (n = 2, 2.3%), as well as radiological interventional (n = 1, 1.1%) options. In 12 cases, erectile dysfunction, mostly temporary, which required phosphodiesterase (PDE)-5 therapy developed. Recurrence and prolonged courses were rare. CONCLUSION IPTCC is a rare disease in young men. Conservative therapy with antithrombotic and analgesic treatment has shown good chances of full recovery. If relapse occurs or the patient refuses antithrombotic treatment, operative/alternative therapy management should be considered.
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Affiliation(s)
- J Schneider
- Klinikum am Steinenberg Reutlingen, Steinenbergstr. 31, 72764, Reutlingen, Deutschland.
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Nguyen V. A case of unprovoked segmental proximal partial thrombosis of the corpus cavernosum. Urol Case Rep 2023; 48:102426. [PMID: 37215060 PMCID: PMC10196997 DOI: 10.1016/j.eucr.2023.102426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Partial thrombosis of the corpus cavernosum is an extremely rare and likely underdiagnosed urologic condition. We discuss a case of a 25-year-old male who presented with severe perineal pain and was diagnosed with idiopathic proximal partial thrombosis of the corpus cavernosum via ultrasound and MRI. The patient experienced symptom resolution with evidence of disease regression on follow up MRI after treatment with direct oral anticoagulation. Further studies are needed to fully delineate the pathophysiology of this condition to facilitate development of standardized diagnostic and treatment algorithms.
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Affiliation(s)
- Vi Nguyen
- Department of Urology University of California, San Diego 9300 Campus Point Drive, La Jolla, CA, 92037, USA.
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Labra A, Cocio R, Niedmann JP, Barroso JP, Osorio F, Lara B. Bilateral partial thrombosis of the corpus cavernosum associated with the use of a stationary bike. Case report and literature review. Urol Case Rep 2023; 48:102414. [PMID: 37215056 PMCID: PMC10193154 DOI: 10.1016/j.eucr.2023.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 05/24/2023] Open
Abstract
Partial and segmental thrombosis of the corpus cavernosum is a rare pathology not entirely understood, however, there are some triggers that have been associated in its appearance. We present a case of a 36-year-old patient with bilateral partial thrombosis of the corpus cavernosum, without priapism, after use of a stationary exercise bike. Ultrasound and magnetic resonance findings are shown, in which bilateral involvement stands out. The patient received conservative management with good response. This pathology is idiopathic and multiple factors have been associated to its origin, one of them being repetitive trauma due to sports activity.
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Affiliation(s)
- Andrés Labra
- Departament of Radiology, Clínica Alemana de Santiago, Chile
| | - Rolando Cocio
- Departament of Radiology, Clínica Alemana de Santiago, Chile
| | | | | | | | - Bastián Lara
- Departament of Radiology, Clínica Alemana de Santiago, Chile
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Ocampo Flórez GM, Obando AC, García-Perdomo HA. Association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome: A scoping review. Andrology 2022; 10:844-851. [PMID: 35460544 DOI: 10.1111/andr.13190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 04/10/2022] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Abstract
AIM To describe the association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome. METHODS An scoping review was performed according to the recommendations of the Joanna Briggs Institute. Moreover, we performed a search strategy using the MEDLINE, EMBASE, and CENTRAL databases. We included the available information, evaluating the conditions of partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome, and their molecular and physiological mechanisms and clinical presentation. RESULTS We identified 207 manuscripts and chose eight studies published between 2001 and 2021. The total number of patients was 34, and their mean age was 28.2 years. Moreover, in 84% of the studies, the pathophysiology of the events was related to microtrauma or prolonged perineal compression. Also, 94.2% of the patients had some degree of erectile dysfunction. In addition, out of all patients, 94% underwent magnetic resonance imaging (MRI). However, patients with hard flaccid syndrome did not show relevant findings in these studies. Conversely, MRIs showed asymmetry in the proximal corpora cavernosa, thrombosed corpus cavernosum segments, and mainly cavernous fibrous septum in patients with partial cavernous thrombosis and partial priapism. CONCLUSION Partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome occurred more frequently in young patients, possibly related to microtraumas that generate cavernous fibrosis and trigger alterations in the erection of the distal portion of the penis. Also, they cause proximal hardening pelvic, perineal pain, painful ejaculations, and cavernous asymmetry. Moreover, the imaging characteristics are similar in patients with partial priapism and partial cavernous thrombosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ginna Marcela Ocampo Flórez
- UROGIV Research Group, School of Medicine, University of Valle, Cali, Colombia.,Department of Urology, CES University, Medellín, Colombia
| | | | - Herney Andrés García-Perdomo
- UROGIV Research Group, School of Medicine, University of Valle, Cali, Colombia.,Division of Urology/Uro-oncology, Department of Surgery, School of Medicine, University of Valle, Cali, Colombia
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Terkmane N, Van Glabeke E, Olicki JM, Andre MH, Benkhelifa AM, Mouheb M. [Partial thrombosis of the corpus cavernosum: A new case with good outcomes under non-steroidal anti-inflammatory drugs]. Prog Urol 2021; 31:503-505. [PMID: 33941456 DOI: 10.1016/j.purol.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 02/23/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022]
Abstract
Partial priapism is a rare pathology with less than 60 cases published in the literature; the etiology remains unknown, although certain favorable factors are identified as having in relation a prolonged perineal compression or a thrombopathy. The symptomatology is characterized by the appearance of pain, perineal edema and an induration of the root of the penis, which do not concern the distal part of the penis or the glans. MRI is the best complementary examination. The first-line surgical treatment is abandoned. Medical treatment with non-steroidal anti-inflammatory drugs or low molecular weight heparins combined with platelet aggregation inhibitors give good results with complete resolution of symptoms in 82% of cases; first-line medical treatment should be favored. We report a case of idiopathic partial priapism, successfully treated with non-steroidal anti-inflammatory without recurrence after 10 years.
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Affiliation(s)
- N Terkmane
- Service d'urologie, Centre hospitalier intercommunal André-Grégoire, Montreuil, France; Fédération interhospitalière d'urologie de Seine Saint-Denis, Paris, France.
| | - E Van Glabeke
- Service d'urologie, Centre hospitalier intercommunal André-Grégoire, Montreuil, France; Fédération interhospitalière d'urologie de Seine Saint-Denis, Paris, France
| | - J-M Olicki
- Service de radiologie, Centre hospitalier intercommunal André-Grégoire, Montreuil, France
| | - M-H Andre
- Service de médecine interne, Centre hospitalier intercommunal André-Grégoire, Montreuil, France
| | - A M Benkhelifa
- Fédération interhospitalière d'urologie de Seine Saint-Denis, Paris, France
| | - M Mouheb
- Service d'urologie, Centre hospitalier intercommunal André-Grégoire, Montreuil, France; Fédération interhospitalière d'urologie de Seine Saint-Denis, Paris, France
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Militello FC, Aredez A, Yarade E, Pérez M. Segmental partial thrombosis of the corpora cavernosa: Case report and diagnostic/therapeutic algorithm. Rev Int Androl 2021; 20:68-72. [PMID: 33632657 DOI: 10.1016/j.androl.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022]
Abstract
Cavernous body thrombosis is a rare condition. The etiology and pathophysiology of this entity is still poorly understood and there is no clear diagnostic and treatment algorithm. The objective of this article is to publish a clinical case of a partial segmental thrombosis of the corpus cavernosum and present a flow chart for diagnosis and treatment based on the review of the published literature on this disease.
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Singh D, Larson T, Campbell K, Dennis M, Yeung L. Surgical Management of Idiopathic Partial Thrombosis of the Corpus Cavernosum. Sex Med 2021; 9:100273. [PMID: 33307340 PMCID: PMC7930853 DOI: 10.1016/j.esxm.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022] Open
Abstract
A 36-year-old African American man presented to the emergency department with 2 days of left-sided perineal pain after sexual activity. He was found to have induration in the left perineum overlying the proximal left corporal body. Clinical picture was suspicious for traumatic corporal rupture; however, advanced imaging showed a proximal segmental thrombosis of the left corpus cavernosum. The patient underwent perineal exploration with evacuation of an intracorporal penile hematoma. In spite of disrupting a fibrous membrane in the proximal corpora and drainage of the corpora, we observed repeat tumescence during the procedure because of an observed arterial high-flow state in the corpora cavernosum. This was resolved with administration of phenylephrine into the cavernosum. The patient had return of normal erectile function 2 days after the procedure with resolution of pain at the site. Singh D, Larson T, Campbell K, et al. Surgical Management of Idiopathic Partial Thrombosis of the Corpus Cavernosum. Sex Med 2021;9:100273.
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Affiliation(s)
- Danish Singh
- University of Florida College of Medicine, Gainesville, FL, USA.
| | - Troy Larson
- Department of Urology, University of Florida College of Medicine Gainesville, FL, USA
| | - Kevin Campbell
- Department of Urology, University of Florida College of Medicine Gainesville, FL, USA
| | - Michael Dennis
- Department of Urology, University of Florida College of Medicine Gainesville, FL, USA
| | - Lawrence Yeung
- Department of Urology, University of Florida College of Medicine Gainesville, FL, USA
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Vieira-Leite C, Baleato-González S, Huelga-Zapico E, García-Figueiras R. Corpus cavernosum thrombosis: The membrane may play its role. Rev Int Androl 2018; 18:35-38. [PMID: 30501935 DOI: 10.1016/j.androl.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/05/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
Partial thrombosis of corpus cavernosum is an uncommon condition that needs a high level of suspicious to be diagnosed. Imaging techniques may be very useful, and MR is the state-of-the-art technique. We present a case of a young male who presented to the emergency department with perineal and painful mass. MR imaging clearly depicted a thrombosed corpus cavernosum and a bilateral membrane that is possibly the underlying predisposing condition. With only conservative treatment the patient had an excellent outcome.
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Affiliation(s)
- Cecília Vieira-Leite
- Radiology Department, Hospital Clínico Universitario de Santiago de Compostela, Spain.
| | | | - Emilio Huelga-Zapico
- Radiology Department, Hospital Clínico Universitario de Santiago de Compostela, Spain
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10
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Affiliation(s)
| | | | - Fabio Noro
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | - Márcio Miguez
- Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
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Ranasinghe SV, Chen M, Roberts MJ, Westera J, Thangasamy I, Dunglison N. Idiopathic partial thrombosis of the corpus cavernosum: An unusual presentation to consider. JOURNAL OF CLINICAL UROLOGY 2018. [DOI: 10.1177/2051415817747476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sachinka V Ranasinghe
- Department of Urology, Royal Brisbane and Women’s Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
| | - Michael Chen
- Department of Urology, Royal Brisbane and Women’s Hospital, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane and Women’s Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Australia
| | - Jurjen Westera
- Department of Urology, Royal Brisbane and Women’s Hospital, Australia
| | - Isaac Thangasamy
- Department of Urology, Royal Brisbane and Women’s Hospital, Australia
| | - Nigel Dunglison
- Department of Urology, Royal Brisbane and Women’s Hospital, Australia
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