The Role of Phosphodiesterase Inhibitors in the Management of Cavernositis With Multifocal Abscesses: A Report of Case Series

Abstract

Introduction: Cavernositis is a rare acute infection of the corporal bodies of the penis. It might result in corporal cavernosal abscesses, fibrosis, and subsequently erectile dysfunction if the treatment is inadequate. Previous reports advocate penile aspiration when cavernosal abscesses were significantly present.

Aim: We report 2 cases of cavernositis treated by the standard antimicrobial therapy in addition to the daily use of phosphodiesterase type 5 inhibitors (iPDE-5).

Methods: We include 2 patients who fulfill the criteria for the diagnosis of cavernositis. They were diagnosed clinically based on history and physical examination. Patient 1 had multifocal abscesses on initial penile contrast-enhanced magnetic resonance imaging (MRI). This patient showed rapid clinical improvement with the addition of phosphodiesterase inhibitor (PDEi) to the antimicrobial therapy without the need for surgical drainage of the abscesses. Patient 2 had persistent infection despite 3 weeks of oral second-generation cephalosporin (Cefuroxime). But he showed significant clinical improvement after being started on PDEi in conjunction with the current antimicrobial therapy. Follow-up after 3 months by clinical examination and penile magnetic resonance imaging in both patients showed normal erectile function with no scarring.

Conclusion: PDEi have promising results on disease progression and outcomes. It synergizes the effect of antimicrobial therapy and can potentially reduce the residual corporal fibrosis and erectile dysfunction. However, large studies are required to validate and generalize this treatment approach. Bakhsh A, Daqqaq T, Alhasan A, et al. The Role of Phosphodiesterase Inhibitors in the Management of Cavernositis With Multifocal Abscesses: A Report of Case Series. Sex Med 2020;8:318-322.

Keywords: Cavernositis; Corpora Cavernosa; Impotence; Phosphodiesterase Type 5 Inhibitor.

Figure 1

Patient 1: Inflammation of the glans of the penis and edematous penile shaft in the flaccid state (Informed written consent was obtained to demonstrate the clinical finding using the photograph).

Figure 2

Patient 1: Magnetic resonance image (MRI) of the penis with multifocal abscesses. (A) Sagittal precontrast T1-weighted MRI. (B) Sagittal T1 after administration of intravenous gadolinium. (C) Coronal postcontrast T1-weighted MRI with fat saturation, showing multiple rounded homogenously enhancing lesions diffusely involving the corpus cavernosum (solid white arrows).

Figure 3

Patient 1: Magnetic resonance imaging (MRI) of the penis after treatment protocol. (A) Sagittal precontrast T1-weighted MRI. (B) Sagittal postcontrast T1-weighted MRI. (C) Coronal T1-weighted MRI after administration of gadolinium. (D) Coronal postcontrast T1-weighted MRI with fat saturation and after treatment showing normal appearance of the corpus cavernosum with complete resolution of the previously seen abscesses.