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Urology/chronic penis injury

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QUESTION: Hello Dr. Leslie,


I have a long standing and very unusual injury(?) on the shaft of my penis. I apologize for the length.
Several years ago in the morning I was showering and noticed a very thin hard cord had appeared that went from the base of the shaft to just below the head and curled to the side, 3/4 of the way up the shaft there was a small bump that was pretty much in line with the hard cord. And just under the head where the cord curled to the side there is a slight bit of lymphatic swelling. Unfortunately, this is all rather hard to see, though easier when erect.
   There was a bit of discomfort from the bump and cord with touching and ejaculation but not a whole lot. I also had Chronic Pelvic Pain Syndrome (CPPS), with penis pain symptoms from that, and not until years later after getting that under control did I realize that more pain was coming from the cord/bump than I realized.
I went to a couple urologists with unsatisfactory outcome.
    16 months ago I was reading about sclerosing lymphangitis, which I thought must be my problem. And people (a couple doctors even, ironically) were mentioning pressing on the swelling to clear the lymph. Which stupidly I did, I held pressure on the hard bump and was not gentle and it kind of flattened.
    This was the worst mistake I've ever made. The bump swelled up, the hard cord hurt way more, the lymph swelling got worse. My whole penis got kind of red and hot, the skin peeled somewhat. Literally a fly landing on the swelling would hurt. Just rubbing against my boxers hurt. Any movement hurt. The vibrations riding in a car hurt. Erections hurt and were swollen. Ejaculating hurts a lot. Inflamed to the max. I haven't masturbated/sex since this incident, as that would certainly destroy my penis.
But there isn't much to see, unfortunately. I went to a urologist and he didn't listen. My GP said he could feel the swollen lump, but that doesn't help me. I think it is the dartos fascia swollen, along with a swollen lymph channel. I used steroid cream I thought helped somewhat but, almost 16 months later it has gotten a lot better but things are still NOT GOOD at ALL.
I'll cut this short as it's so long but just wondering what you think of this horrible situation and who you would recommend seeing as I would travel anywhere. As there is not much to be seen or felt, I just feel it would be so hard to get someone to take me seriously and willing to try surgery.

Thank you, Dr. Leslie.

ANSWER: Jim:
This sounds like a fairly severe and unusual problem.  My suggestion would be to go to the nearest tertiary care university center with a urology residency program and consult their urology department.

---------- FOLLOW-UP ----------

QUESTION: Hi Dr Leslie,
I asked you this prior question a couple months ago and am still waiting to see another urologist (I'm in Canada...sigh). Basically my current question is based on the fact that I am sure I have a chronic very inflammatory injury (swelling) of a small spot of dartos fascia just several millimeters wide when erect (it expands with erection). As well as what seems to be a swollen lymph channel. It does not seem likely these will fully heal and the symptoms which I described in my prior post which I'll omit to save space, are very bad.
I have yet to find any evidence of anyone having dealt with swollen/inflamed dartos fascia in the penile shaft on the entire web/medical journals, and would just like to know if you have ever heard of this happening?
As well, would it be possible to cut out the symptomatic part of the fascia and stitch the two sides together? Or something else?

I just don't know what to do as there isn't much to see and I feel I will just have to head to the USA and just keep going to urologists until someone will even just listen to me, let alone consider surgery.

Thanks for any reply, this is really ruining my life.

Answer
Jim:

You asked if I have ever heard of the type of injury you've described and the answer is no.  

A fascia should not expand with an erection and there are limited lymph channels in the penis.

My advice is to look at going to the US and seeing a specialist there since it appears you cannot get a timely appointment in Canada.  Many major US centers see Canadian patients all the time and the cost for a single visit/consultation is not prohibitive.  For example, the Cleveland Clinic has an outstanding Urology department and is readily accessible from Canada.  Good luck.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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