Penile Abscess Secondary to Neglected Penile Fracture after Intracavernosal Vasoactive Drug Injection
A 51-year-old man was referred with complaints of a painful swollen mass on the proximal penile shaft. The swelling was complicated by severe pain and gradual penile detumescence without a snap-pop sound during sexual intercourse after intracavernosal injection 9 days earlier. No more erections were reported thereafter. In spite of antibiotics and pain medications from a private clinic for a week, painful penile swelling has gradually progressed. The patient had been on medications for diabetes mellitus and hypertension for about 10 years, and he had a history of self-injection of petroleum jelly into the penis over the previous 20 years. The patient denied any history suggestive of sexually transmitted diseases.\nOn physical examination, he was afebrile and hemodynamically stable. A 5 cm tender and swollen mass was palpable on the ventral aspect of the right proximal penile shaft (). The phallus deviated to the left side because of the mass effect. The petroleum jelly infiltrated skin was confined to the distal penile shaft, circumferentially. The external urethral meatus showed no discharge. Both testes and epididymides were palpably normal, and the inguinal lymph nodes were not enlarged. A rectal examination was also unremarkable.\nThe random blood sugar (323 mg/dl) and white blood cell count (12,800/mm3) were elevated. Urine analysis and culture showed no evidence of infection. The serology for human immunodeficiency virus (HIV) and syphilis, and urine culture for tuberculosis were negative, as well. Penile ultrasonography showed an approximately 3.5 cm mixed echoic fluid collection along the right side of the penile shaft ().\nUnder spinal anesthesia, the thickened Buck's fascia over the penile abscess was incised, and about 10 ml of pus with a blood clot was drained (). The culture of the abscess yielded Enterococcous faecalis. After irrigation with saline and povidone iodine inside of the abscess cavity, we found the ruptured tunica albuginea about 1 cm in length (). However, the cavernosal tissue was intact without evidence of severe inflammatory change. The ruptured tunica albuginea was closed with Vicryl 4-0 interrupted sutures. The patient was discharged from the hospital on the day after surgery. During the follow up, superficial wound dehiscence occurred but healed after meticulous dressing and secondary wound closure.