A Case Study Describing Successful Treatment of Recurrent Penile Abscesses using the Carrion Cast
Lael Reinstatler, MD, MPH1, Martin Gross, MD1, Ricardo Munarriz, MD2.
1Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2Boston University, Boston, MA, USA.
BACKGROUND: The Carrion cast was first published in 2015 as a technique for treating infected penile prostheses. Here we describe a case report applying this procedure to a persistent penile abscess with success. METHODS: This is a case report. RESULTS: A 67-year-old gentleman without significant past medical history presented to an ER with penile pain and swelling. Upon presentation he had clinical signs of infection with a temperature to 103F and WBC of 15. Urinalysis was positive only for trace blood. Due to a contrast allergy, non-contrast CT scan of the pelvis was ordered which showed left greater than right penile swelling without discrete abscess or collection. He was observed on IV antibiotics without significant improvement for 48 hours when gadolinium-MRI was obtained. This revealed bilateral 8x1.5cm corporal abscesses. Upon further questioning, the patient revealed that three weeks prior to this event he had performed masturbation to include placing an earthworm and barbecue skewer per his urethra. Of note, the worm was removed intact. Once this history was obtained and based on persistent signs of infection, he was taken to the OR for washout via penoscrotal approach. Purulent material was encountered, washed out with triple antibiotic solution (vancomycin/zosyn/amphotericin), drains were placed and the incision was closed. His cultures grew streptococcus constellatus and he was transitioned to augmentin and discharged home several days later. He was seen in clinic in follow-up four weeks later where recurrent abscesses were suspected. Cystoscopy in the office was negative for fistula. He refused hospital admission given the Christmas Holiday but presented a day later for admission for IV antibiotics and repeat MRI which also ruled out a fistula and demonstrated recurrent bilateral abscesses. He was taken to the OR where the abscesses where washed out and calcium sulfate beads with vancomycin and tobramycin were instilled into both corporal spaces, as previously described by Dr. Carrion. Ultimately, he recovered from this second procedure, was discharged home, and has been seen in clinic with complete recovery and no further infectious issues.
CONCLUSIONS: In addition to usage in the infected penile prosthesis context, the Carrion cast may be applied to penile abscesses unrelated to prostheses.
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