Idiopathic Partial Thrombosis (IPT) of the Corpus Cavernosum: A Hypothesis-Generating Case Series and Review of the Literature

Abstract

Introduction Idiopathic partial thrombosis (IPT) of the corpus cavernosum is a rare condition. The etiology is not fully understood; however, the presence of an either or not congenital web in these patients may contribute to the development of IPT. Aim The aim of this study was to describe 18 new IPT cases and compare these with 38 cases found in the literature. Methods A multicenter retrospective analysis was performed. Descriptive statistics are given. Main Outcome Measures The main outcome measures used were clinical presentation, clinical and radiographical diagnostics, treatment and resolution of symptoms. Results Patients most frequently presented with perineal swelling (10/18; 56%) and pain (13/18; 72%), unilateral (12/18; 67%) or bilateral (4/18; 22%), and pain during erection (10/18; 72%). Penile curvature, dysuria or fever (each 1/18; 6%) were uncommon presenting symptoms. In our series, magnetic resonance imaging demonstrated a fibrous web in the corpus cavernosum in 100% of cases and was more bilaterally (11/18; 61%) than unilaterally (7/18; 39%) diagnosed. Cycling was found to be a provocative factor for IPT occurrence in patients at risk as 61% (11/18) of patients reported being a frequent cyclist with the episode of IPT occurring immediately after or during cycling activity in 8 out of 18 patients (8/18; 44%). In five centers, 15 patients were treated conservatively, the majority being treated with therapeutic doses of low molecular weight heparin and simultaneous anti-aggregant therapy. In one center, all three patients were treated with a surgical approach. Complete resolution of symptoms was noted in only 50% of cases. Conclusion IPT is a condition that presents typically with perineal pain and swelling. Cycling is often seen as a provocative factor, while the presence of a fibrous web at the level of the crurocavernosal junction is the underlying disorder allowing for entrapment of blood in the crura. Conservative treatment provides a reasonably good outcome in most cases. For therapy resistant cases, surgery can be considered.

Partial segmental thrombosis of the corpus cavernosum presenting with perineal pain

“…Ilicki et al 27 suggested a two-hit model in which a transverse membrane divides the corpus into a proximal and distal portion and a trigger event such as microtrauma during vigorous sexual activity or prolonged cycling resulting in the formation of the thrombus. 36 We suspect that the cause of the PSTCC in this case was a combination of microtrauma during cycling and the presence of a fibrous septum illustrated in figure 1 9 11 14 18 30 31 33 36. This theory has also been proposed in recent case series published by Weyne et al 33…”

“…The underlying cause is still unclear, but in earlier case reports where surgical exploration was the preferred management for pain, a fibrous septum was found within the corpus cavernosum separating the proximal part of the thrombus from the uninvolved distal corpus cavernosum 1–3 11 23 27 33. Ilicki et al 27 suggested a two-hit model in which a transverse membrane divides the corpus into a proximal and distal portion and a trigger event such as microtrauma during vigorous sexual activity or prolonged cycling resulting in the formation of the thrombus.…”

“…Depending on the position of the thrombus, the penis can appear semierect 6 27 32 33. It almost always occurs unilaterally and bilateral PSTCC has been rarely reported 1 33. Although it has been described in the past as partial priapism, a prolonged and painful erection is not always present 1–8 10.…”

Case report. Het herkennen en behandelen van een idiopathische partiële trombose van het corpus cavernosum, een zeldzaam en wellicht onbekend fenomeen in de acute urologie

“…Toch lijkt het ontstaan meestal idiopathisch [1][2][3][4][5][6][7][8][9][10][11]. Wel verdient het aanbeveling om hematologische tests te verrichten of de patiënt voor dergelijke tests door te verwijzen naar de hematoloog.…”

“…Wel verdient het aanbeveling om hematologische tests te verrichten of de patiënt voor dergelijke tests door te verwijzen naar de hematoloog. Weyne et al beschrijven dat bij patiënten met een stollingsstoornis de aandoening vaker optreedt [1]. Een interessant gegeven is dat in veel gevallen op MRI-beelden een dunne membraan werd gezien in de corpora cavernosa bij patiënten met segmentaal priapisme, terwijl dit membraam ontbrak op MRI-beelden bij controlegroepen [6].…”