“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

Norman, Mackenzie B; Vitale, Kenneth

doi:10.1016/j.ijscr.2020.07.029

Cited by 5 publications

(6 citation statements)

References 13 publications

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“…Chronic lymphedema resulting in the development of fibrous tissue has also been suggested as an etiological pathway of PNI [4]. Histopathological findings vary but tend to show necrosis of the superficial perineal fascia with myxoid degeneration of collagen fibers and fatty tissue, as well as occasional formation of a central pseudocyst [2][3][4][5]12,15]. In large PNIs, the skin condition with non-healing, exuding wounds often resembles other lymphatic problems, such as elephantiasis.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, imaging modalities, such as ultrasound and magnetic resonance imaging, can be used as non-invasive techniques to secure a diagnosis [13]. An algorithm published by Norman et al in a case report in 2020 may also help reach a diagnosis in unclear cases [5].…”

Section: Discussionmentioning

confidence: 99%

“…Perineal nodular induration (PNI), more commonly known as "third testicle" or "cyclist's nodule" [1], is a rare and benign (myo)fibroblastic pseudotumor associated with saddle sports, such as cycling or horseback-riding [2][3][4][5][6]. The clinical appearance of PNI is characterized by unspecific swelling of the soft tissue posterior at the perineum or over the ischial tuberosity [7].…”

Section: Introductionmentioning

confidence: 99%

“…The aim of this article Is to contribute to the existing body of knowledge by providing a comprehensive review of the current literature while also introducing an innovative surgical approach for managing PNI. We hope that this article draws attention to the rather rare but also likely underdiagnosed condition of PNI [5], with special focus on the surgical treatment in cases of large PNI.…”

Section: Introductionmentioning

confidence: 99%

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How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach

Mayer,

Spies,

Mayer

et al. 2024

JCM

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Background: Perineal nodular induration (PNI) is a benign proliferation of the soft tissue in the perineal region that is associated with saddle sports, especially road cycling. The etiology has not been conclusively clarified; however, repeated microtrauma to the collagen and subcutaneous fat tissue by pressure, vibration and shear forces is considered a mechanical pathomechanism. In this context, chronic lymphedema resulting in the development of fibrous tissue has been suggested as an etiological pathway of PNI. The primary aim of this study was to introduce and elucidate a novel operative technique regarding PNI that is assisted by indocyanine green (ICG). In order to provide some context for this approach, we conducted a comprehensive review of the existing literature. This dual objective aimed to contribute to the existing body of knowledge while introducing an innovative surgical approach for managing PNI. Methods: We reviewed publications relating to PNI published between 1990 and 2023. In addition to the thorough review of the literature, we presented our novel surgical approach. We described how this elaborate approach for extensive cases of PNI involves surgical excision combined with tissue doubling and intraoperative ICG visualization for exact lymphatic vessel obliteration to minimize the risk of recurrence based on the presumed context of lymphatic congestion. Results: The literature research yielded 16 PubMed articles encompassing 23 cases of perineal nodular induration (PNI) or cyclist’s nodule. Of these, 9 cases involved females, and 14 involved males. Conservative treatment was documented in 7 cases (30%), while surgical approaches were reported in 16 cases (70%). Notably, a limited number of articles focused on histopathological or radiological characteristics, with a shortage of structured reviews on surgical treatment options. Only two articles provided detailed insights into surgical techniques. Similarly to the two cases of surgical intervention identified in the literature research, the post-operative recovery in our ICG assisted surgical approach was prompt, meaning a return to cycling was possible six weeks after surgery. At the end of the observation period (twelve months after surgery), regular scar formation and no signs of recurrence were seen. Conclusion: We hope that this article draws attention to the condition of PNI in times of increasing popularity of cycling as a sport. We aimed to contribute to the existing body of knowledge through our thorough review of the existing literature while introducing an innovative surgical approach for managing PNI. Due to the successful outcome, the combination of tissue doubling, intraoperative ICG visualization and postoperative negative wound therapy should be considered as a therapeutic strategy in cases of large PNI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach

Mayer,

Spies,

Mayer

et al. 2024

JCM

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“…«Узелок байкера», или УУП, также известное как «узелок велосипедиста», «седалищная гигрома», «третье яичко», является редким явлением, характерным для людей, чаще мужчин, занимающихся «седловыми» видами спорта профессионально [1,2]. Считается, что это результат повторяющейся микротравмы, вызванной сдавливанием поверхностной фасции промежности и мягких тканей между седлом и седалищными буграми, а также вибрацией, оказываемой седлом на область промежности [3][4][5]. Узелок может быть одно-или двухсторонним в зависимости от того, какая сторона испытывает наибольшее давление и трение во время тренировок.…”

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Magnetic Resonance Imaging in the Diagnosis of Perineal Nodule Indurations in Professional Cyclists

Shtentsel¹,

Maschenko²,

Kuzmin³

et al. 2021

СПНО (MPSE)

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Узловое уплотнение промежности (УУП, perineal nodular induration-PNI), также известное как «узелок велосипедиста», -ведущая патология профессиональных велосипедистов, которая может приводить к вынужденному длительному прекращению тренировочной и соревновательной деятельности, что негативно сказывается на функциональном состоянии и ставит под сомнение продолжение спортивной карьеры на прежнем уровне. Важной задачей является точная, ранняя и безопасная неинвазивная диагностика узлового уплотнения промежности с целью профилактики и соответствующего лечения. В настоящее время не существует четких критериев диагностики и алгоритма маршрутизации этих пациентов в соответствии с выявленными изменениями при магнитно-резонансном (МРТ) исследовании и степенью клинических проявлений. В условиях популяризации велосипедного спорта медицинские специалисты должны знать о диагностических особенностях данной патологии. Целью данной статьи является определение МР-критериев узлового уплотнения промежности, соответствующих различным степеням его клинических проявлений, у профессиональных велосипедистов. В соответствии с тяжестью клинических проявлений и МР-картиной выделяли три степени: легкую, среднюю и тяжелую. Легкая степень (n=6, 50%), средняя (n=4, 33,3%), тяжелая степень (n=2, 16,7%). МРТ-диагностика УУП в группе профессиональных велосипедистов способствовала точному топографо-анатомическому определению зон патологических изменений и выявлению МР-критериев, специфичных для стадии заболевания. Ключевые слова: узловое уплотнение промежности, лучевая диагностика, магнитно-резонансная томография (МРТ), профессиональные велосипедисты, «узелок байкера», гигрома.

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Pressure and Skin: A Review of Disease Entities Driven or Influenced by Mechanical Pressure

Chien,

Tsai

2023

Am J Clin Dermatol

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“Bumpy” ride for the female cyclist: A rare case of perineal nodular induration, the ischial hygroma

Cited by 5 publications

References 13 publications

How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach

How to Treat a Cyclist’s Nodule?—Introduction of a Novel, ICG-Assisted Approach

Magnetic Resonance Imaging in the Diagnosis of Perineal Nodule Indurations in Professional Cyclists

Pressure and Skin: A Review of Disease Entities Driven or Influenced by Mechanical Pressure

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