包皮膿瘍因包莖所引起的少見併發症－病例報告與文獻回顧

吳冠賢^1,2,3, 曾世一^3*

¹高雄醫學大學附設中和醫院 泌尿部、²高雄醫學大學 臨床醫學研究所、³高雄市立大同醫院 泌尿部

A Secondary Complication of Phimosis-Induced Preputial Abscess: Case report and review of literature

Kuan-Hsien Wu^1,2,3, Shih-Yi Tseng^3*

¹ Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

² Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

³Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

Introduction: Phimosis is characterized by the partial or complete inability to retract the foreskin of the penis. Uncircumcised individuals are at a higher risk of developing complications such as paraphimosis, balanitis, and even tumors. Balanoposthitis commonly involves Candida albicans as the predominant pathogen, and the incidence rate ranged between 6-11% in phimosis patients.

Case report: A 41-year-old man presented to Emergency Department complaining of painful penile swelling with smelly discharge. He reported having masturbation one week ago. Physical examination showed phimosis, heated and swelling foreskin and penis, without tenderness at bilateral testes. He had no significant past medical or surgical history, without sexual history in recent month. Blood analysis revealed leukocytosis, and elevated C-Reactive Protein level. Pus culture yielded Peptoniphilus harei, Enterococcus faecalis. Computed tomography depicted an abnormal fluid collection of low attenuation with surrounding rim-enhancement from foreskin to penis root. Antibiotic agent with amoxicilin and clavulanic acid was prescribed. Cystoscopy showed discharge from the preputial cavity, the space between the foreskin and the distal penis. He was treated by incision and drainage. The patient was discharged after one week treatment.

Conclusion: There are few cases in literature describing clinical preputial abscess, which is a rare complication of severe balanoposthitis. Physical examination, blood analysis, and imaging studies can aid in achieving a clearer diagnosis. An early surgical management is necessary to prevent the progression of complications.