(PNM-57) A penile abscess in a patient with previous history of a corpora cavernosa excision as a differential diagnose of priapism: a case report

Abstract Objective Patients with sickle cell disease may present with urological complications such as priapism. Acute management of priapism follows a therapeutic ladder ranging from conservative measures to surgical interventions in 10–30% of cases, including penile shunting and, in extreme scenarios, cavernosal excision. This case report describes a patient with previous history of penile surgery who later presented with penile tumescence and was ultimately diagnosed with penile abscess. Material and Methods A 37-year-old male with sickle cell anemia under optimized outpatient care presented with 20 hours of painful, non-intentional penile tumescence with purulent urethral discharge for the past 7 days. History included multiple emergency visits for priapism requiring intracavernosal alpha-agonists and a previous corpora cavernosa removal 12 years before. Cavernosal aspiration for gasometry yielded dense purulent fluid. Penile ultrasound revealed heterogeneous fluid–fluid level collection at the base of the penis, with visualization of proximal corpora cavernosa only. Surgical drainage was performed, with placement of a laminar drain and 18Fr urethral cateter. Broad-spectrum endovenous antibiotics were administered. Urethrocystography and laboratory testing of the drained liquid excluded urethral fistula. The patient was discharged on the 7th postoperative day. No recurrence was reported after 6 months. The patient presents no urinary symptoms. Results The therapeutic ladder for priapism is well established, with a relatively low rate of emergency surgical interventions. However, atypical symptoms such as urethral discharge and prior surgical manipulation should prompt further evaluation to rule out differential diagnoses, including penile abscess. Conclusion Although rare, penile abscess should be considered in the differential diagnosis of priapism, particularly in patients with history of prior surgical interventions and urethritis. Financing No conflict.