包皮環切手術後之陰莖蟹足腫：個案報告及文獻回顧

林瑞穎、劉冠麟、林政鋒、林承家、陳文祥、吳翊豪、陳鴻毅

基隆長庚醫院 外科部 泌尿科

Case report and literature review of penile keloid after circumcision

Jui-Ying Lin, Kuan-Lin Liu, Cheng-Feng Lin, Cheng-Chia Lin, Wen-Hsiang Chen, Yi-Hao Wu, Hong-Yi Chen

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Background:

Circumcision is one of the most common performed surgical procedures worldwide.^[1,4,5] Although the complication rate in circumcision is very low ranging from 0.5% to 2.9%, such as bleeding, infection, diminished penile sensation, urethral injury or amputation of the glans may be seen.^[1,4,5] Keloid is the result of excessive deposition of collagen fibers in dermis and subcutaneous tissue.^[1,2,3,4,5] It usually develops at the site of trauma or surgical injury.^[1,2,3,5] Keloid formation on the penis, where skin tension is minimal, is a very rare condition.^[1,2,3,4,5] Herein, we report a case of keloid that developed post-circumcision, including a review of the literature.

Case presentations:

We report the case of an 18-year-old man with past history of phimosis, status post traditional circumcision on 2022/07/29, presenting with keloid at distal dorsal side of prepuce. He denied erection pain, pruritus or discharge. He visited our clinic for help on 2024/02/06. Complete excision of dorsal penile keloid scar and circumcision were performed by urologic surgeon on 2023/03/18. Local flap and primary closure with 4-0 Vicryl were done by Plasty surgeon on the same day. At out-patient department, his operative wound was well healing.

Discussion:

The most common etiological factor of penile keloid is circumcision (58%).^[2,3] Other risk factors include skin trauma, prolonged wound healing, wound in certain regions (ex. chest, shoulder, back of neck), infection, inflammation family history and acnes.^[2,3,4,5] It seem to be more prevalent in teenagers and young adult due to more important role of immunological and hormonal factors in this age.^[2,3] The time of appearance of the keloid after initial surgical or traumatic event ranges from 2 to 36 months.^[2,5] There are many managements of keloid, such as silicone gel sheets, pressure therapy, cryosurgery, intralesional steroid injection and massage with topical steroids.^[1,2,3,4,5] Optimal treatment usually consists of combination of these therapies.^[1,2,3,4] Surgical excision alone will result in significant local recurrence.^[1,2,3] The most common therapy is combination of excision and pre- or post- intralesional steroid injection which reduces the recurrence rate from about 97% to 50%.^[1,2,3,5] Though radiation is common to treat keloids, it is not an optimal option due to the close proximity of testis.^[2,3,4,5]

Conclusion:

Penile keloids often develop post-circumcision, a rare yet troubling issue requiring close monitoring. Treatment options include surgical removal, supplemented with intralesional steroid injections or topical treatments. Left unaddressed, it may lead to future functional problems like aesthetic discomfort, abnormal erections, sexual dysfunction, and voiding difficulties.