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Forum Name: Urology Topics

Question: hourglass deformity only in partial erections, tenderness


 houev - Wed Jul 14, 2010 1:24 pm

Hi,

I am a 29-year-old single male. Since about 2 years ago, sometimes when my erection is inflating or deflating it appears pinched in the middle. When fully erect this area fills out and looks normal. A peyronie's specialist said I did not have it and could not give me a clear diagnosis. He did not feel any plaque. I also have mild ache/tenderness in the penis shaft while getting/having erections, and the half of my penis farther away from the body tends to be firmer than the closer half during erection. I have mild burning when urinating soon after ejaculation, but that has been the case for years and is mild enough to never have caused me concern. Finally, I have noticed in recent months an increased prominence of veins on the penis.

I realize that things could be far worse, but this situation has nevertheless resulted in a huge loss of sexual confidence and a fear for my future sexual health. I would love to understand better what happened and would be grateful for any insight you can provide.
 Dr.M.Aroon kamath - Mon Aug 16, 2010 4:56 am

User avatar Hi,
Based on your description alone, it is rather difficult to offer a definitive opinion. However, there is one condition that comes close to that description and that is,
"fibrosis of the corpus cavernosum"(corporeal fibrosis).

This condition can be
- diffuse,
- segmental (proximal or distal segmental),
- circumferential,or
- circumscribed fibrosis of the septum penis alone.


Causative factors may be
- trauma to the penile shaft or perenium,
- intracavernosal injection of vasoactive drugs in the treatment of impotence,
- low-flow priapism,
- Diabetes mellitus(increases the risk),
- following radical prostatectomy(even nerve sparing),
- following external beam radiotherapy(ex; carcinoma of prostate),and
- parenteral drug abuse (when drugs like cocaine or heroin are injected into the superficial dorsal vein of the penis)

Recently, a new syndrome has been described - the "hypoactive corpus cavernosum syndrome".In this condition, histopathology has shown fragmentation of the collagen and elastic fibers within the corpora as well as degeneration of the smooth muscles. This condition often does not respond to intracavernosal injections and ultimately requires penile implants.

In recent years, there has been growing concern about the risk of penile fibrosis in sports such as equestrian, biking and cycle racing. There is a worry about 'microtrauma' to the corpora cavernosa due to repeated compressions against the pubic bone, resulting in fibrosis of the corpora cavernosa. Further studies are needed at this point to substantiate this connection.

Diffuse corporeal fibrosis following priapism may make subsequent placement of a penile prosthesis, especially inflatable devices, difficult or even impossible.

The features that you have described are very similar to proximal corporeal fibrosis or circumscribed fibrosis of the septum penis. In this condition, the proximal(the part closer to the body) appears thinned out and firm even in the flaccid condition of the penis. During erections, this part appears thinner in girth compared to the normal distal part. Unlike peyronie's disease,there will be no penile curvature. You have not indicated whether you are a diabetic.

Only your doctor will be able to examine you and come to a definitive diagnosis.
Best wishes!

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