Treatment of tunica albuginea defect using double-breasted corporoplasty (Alei’s technique) and small intestinal submucosa graft

Introduction and importance: An isolated, spontaneous defect of the tunica albuginea is an exceptionally rare condition characterized by localized thinning of its layers and herniation of cavernous tissue. Given the very limited number of reported cases and the absence of standardized management, each report contributes valuable insights into diagnostic and surgical strategies. This case highlights a reconstructive approach aimed at preserving both functional and cosmetic outcomes. Case presentation: A 26-year-old white male presented with a history of mild pain and discomfort at the base of the penis during sexual activity. Examination revealed a soft, reducible swelling on the right side of the penile root during erection. Duplex ultrasound and magnetic resonance imaging confirmed a defect in the tunica albuginea with herniation of cavernous tissue extending 12 mm. Surgical repair was performed using a double-breasted corporoplasty to reinforce the tunica, combined with a small intestinal submucosa graft for additional support. At the 12-month follow-up, the patient showed full erectile function, no recurrence, and complete radiologic resolution. Clinical discussion: Focal defects of the tunica albuginea are poorly understood, with no established causes or treatment guidelines. Surgical management aims to restore structural integrity while preserving erectile function and esthetic appearance. The double-breasted technique provides durable reinforcement by overlapping tunical layers, reducing the risk of recurrence. The graft further enhances mechanical strength. Conclusion: This approach appears to be a reliable surgical option for rare tunical defects, preserving both function and anatomy.