(P29) the curious case of the bony penis

Abstract Background Ossification of the penis is extremely uncommon, with only a few histologically confirmed cases documented. Peyronie’s disease (PD) is the most frequently associated condition leading to penile ossification, but it is commonly localized to a certain area within the shaft of the penis. Other conditions, such as gout, advanced renal disease, diabetes mellitus, hyperparathyroidism, and local trauma, have also been associated with this rare occurrence. We present a unique case of nearly complete penile ossification of the corporal bodies, confirmed through histological examination. Additionally, we provide a summary of the literature on this unusual condition. Methods We present the full journey of our patient, beginning from the early onset of his rare penile shaft condition and its progression to a completely hard penis from coronal sulcus to penile base, preventing bending during its flaccid state. We report the results of his preoperative examination, labs, and imaging. Moving on to his exploration and attempt at penile prosthesis implantation, we demonstrate operative details and postoperative results, including a pathology report with actual video clips and pictures. Our follow-up was for six months. In the conclusion, our report also reviews the existing literature on this rare condition. Results Our patient presented to us complaining of treatment-refractory erectile dysfunction (ED) and premature ejaculation. He had felt an area of induration within his penis six years prior to his ED, which progressed to include most of the penis despite being treated conservatively with vitamin E and colchicine. By inspection, he showed a buried penis owing to his obesity. Upon palpation, we felt a painless hard penis from corona to base, preventing bending during flaccidity. Surgical exploration, performed via a longitudinal penoscrotal incision, revealed diffuse areas of osseous plates under the tunica albuginea, which were completely excised distally in a piecemeal fashion, leaving minimal parts proximally within the crura. We succeeded in implanting a size 12 cm inflatable penile prosthesis with a 6 cm rear tip extender. Postoperative pathology of the excised calcified plaques revealed osseous metaplasia. The patient was satisfied with his implant and erectile function six months after the surgery. Conclusion The cause of penile ossification is still debated. Penile ossification is thought to result from a metaplastic process due to local trauma or as a late stage of PD. In our patient’s situation, the ossification could not be linked to any previous systemic or local predisposing factor, leaving its origin unknown. To our knowledge, this may be the second case to be reported in the literature.