14
ESSM
Today
Study cases from ISSM List
by Natalio Cruz
dr. natalio cruz
Urologist, Head of Andrology Unit
Htal. Univ. Virgen del Rocío
Andromedi. Fátima Clinic
Sevilla, Spain
“Partial Segmental Thrombosis” vs. “Frac-
ture of the proximal part” of the Corpus
Cavernosum
In July 2013 Richard Grunet posted a very in-
teresting and practical case in the ISSM Forum:
I have a 38 yr white male that I was consulted on
in the emergency room last night who described
a 4 day history of right perineal pain after sexual
activity. He initially presented 4 days earlier to our
ER and underwent an exam that demonstrated
a tender firm right cavernosum at the base. He
underwent a duplex US that confirmed a dilated
right cavernosum and otherwise normal flow.
The call team at that time diagnosed him with
“Partial Priapism” and discharged him on full
dose aspirin.
He continued to have discomfort and sight pro-
gression on self exam and came back to the
ER. I was consulted and obtained a Hx of this
occurring in the past about 10 years ago, and on
several episodes after that that according to the
patient all resolved with sexual activity.
His exam demonstrated a tender, thrombosed
right cavernosal base. His left side and distal
right cavernosum were normal. I obtained a
pelvic MRI which confirmed the diagnosis of
segmental thrombosis and additional views of
the pelvic venous anatomy were normal.
He has had a negative work-up including the
usual sickle prep, he has no Hx of illicit drug
use, no Hx of trauma and had normal coagula-
tion labs. We consulted hematology that ordered
additional coagulation studies and started him
on Lovenox. They felt that it was essential to
prevent any additional clot propagation. He is
being seen in their clinic today.
Any one else who has experience with this? Any thoughts about any additional work-up
or therapies to reduce his future risk of recurrence, i.e. ASA and tadalafil?
Maarten Albersen posted immediately:
Dear Richard,
This is not such an uncommon manifestation as you might initially think. We pooled three
cases with two institutions and wrote practice recommendations:
Scand J Urol. 2013 Apr;47(2):163-8. doi: 10.3109/00365599.2012.698305.
Epub 2012 Jul 5.
Idiopathic partial thrombosis of the corpus cavernosum: Aetiology,
diagnosis and treatment.
Hulth M, Albersen M, Fode M, Peeters K, Ramskov KL, Joniau S,
Bisbjerg R, Sønksen J.
Your case most certainly has a ‘web’, too. We have seen it in cyclists, but I believe it is congenital
(and predisposing to partial priapism, or crural thrombosis), although I am not able to explain it
by embryology as there is no fusion go embryological structure at that spot… In our experience,
patients with such kind of a ‘web’ will easily recur, although we have not dared to operate on
it because of the risk of damage to the cavernous artery right there in the junction of crus and
corpus. What are you planning to do? Please note you can see the ‘web’-like structure in the
contralateral corpus, too. The cycling is likely the luxating factor in our cases, while the web is
likely the underlying, predisposing condition…
Best, Maarten
Tuan Le Anh posted:
Dear Richard,
I think that:
You asked about the position of the patient in every painful sex intercourse, there is any rela-
tionship between the position woman – on – top and pain after sex or not.
1. A repetitive trauma related to posture could create some small lesions in the tunica albuginea
and hematoma around the crura of the penis (chronic Penile fracture), which this can create
chronic pain condition, and fibrosis around the lesion location.
2. Another condition is that there is a NIDUS (lesions web – like/Arterio – venous Malforma-
tion – AVM) in the proximal corpora cavernosa.
Checking with MRI (focus on the region of Proximal corpora cavernosa), combined with a
prostaglandin injection in the survey will give clearer picture. You can see the link below to
have more information of MRI technique.
