Abstract
Introduction
Corporal tunneling is reserved for refractory ischemic priapism and carries known risks of fibrosis and erectile dysfunction. Corporal cavernosal herniation is an exceedingly rare and underreported complication characterized by focal outpouching of the cavernosal tissue following corporal intervention. We present a case of bilateral corporal herniations diagnosed by MRI 10 months after corporal tunneling.
Case Info
A 28-year-old male presented to the emergency department with 24 hours of priapism refractory to aspiration, irrigation, and phenylephrine. Urology performed corporal tunneling with irrigation and intracavernosal phenylephrine, achieving detumescence. At one-month follow-up, he had palpable, nontender induration at the surgical sites and new erectile dysfunction, attributed to expected postsurgical change with fibrosis. Follow up examinations at five and nine months revealed similar physical exam findings and discomfort associated with the indurations. This prompted dedicated penile MRI to delineate fibrosis vs corporal herniation. MRI revealed bilateral corporal cavernosal herniations with intact tunica albuginea, measuring 2.7 × 1.6 × 2.2 cm on the right and 2.1 × 2.4 × 2.9 cm on the left. Incidental findings of absent enhancement with T1 hypointensity in the anterior right corpus cavernosum concerning for infarction were also noted. He was scheduled for hernia excision with corporal body reconstruction.
Disc Clinical
The mechanism of corporal cavernosal herniation is uncertain but may relate to focal disruption or weakening of the corporal architecture following tunneling. Because initial induration may mimic expected postsurgical fibrosis on physical exam alone, diagnosis is frequently delayed. MRI can help distinguish herniation from postoperative fibrotic change and identify associated complications such as ischemia or infarction, providing valuable anatomic characterization when postoperative induration persists or evolves.
Conclusion
This case highlights corporal cavernosal herniation as a rare, delayed complication of corporal tunneling and demonstrates the essential role of MRI in diagnosis when postoperative induration persists or evolves beyond the expected postsurgical course.