Ces Urol 2011, 15(4):244-250 | DOI: 10.48095/cccu2011042

Radical surgical treatment of hidradenitis suppurativa of penis and scrotum

Milan Hora¹, Michal Sviták², Vlastimil Bursa², Petr Stránský¹, Viktor Eret¹, Tomáš Ürge¹, Ondřej Hes³, Denisa Kacerovská³, Karel Pizinger⁴

¹ Urologická klinika LF UK a FN, Plzeň

² Oddělení plastické chirurgie LF UK a FN, Plzeň

³ Šiklův patologicko-anatomický ústav LF UK a FN, Plzeň

⁴ Dermatovenerologická klinika LF UK a FN, Plzeň

Introduction:
Hidradenitis suppurativa (HS) or recently acne inversa is a relatively rare chronic purulent bacterial apocrine gland disease of primarily areas of axillae and perigenitals with massive inflammatory infiltrations and fistulae. It affects both genders, but men are more often. Advanced forms requiring surgical solutions are on average after 40 years of age. The finding is usually solved by plastic surgeons. It may occur a case affecting the male genitals and there is a necessary cooperation with a urologist. This case is presented from the urologie perspective.

Case report:
A 47-year old men, with a many years' history of HS of his scrotal skin, the perineum and the internal surfaces of the thighs. Also with acne changes on the face, chest, back. There has been a status of conservative treatment for many years and continues to be exacerbated by the work of this patient - 12 hours a day in a dusty environment, with a minimum of hygiene. After a few weeks of local baths with Betadine® and the later days of antibiotic treatment of co-amoxicillin for mixed bacterial infection, a radical excision was carried out in cooperation with a urologist and a plastic surgeon - removal of the scrotum (a specimen of 4,5 kg), skin of the perineum and a part of the internal sides of the thighs. Testicles were implanted under the skin of the thighs. On 15th postoperative day, recovery of tissues was carried out with a scalpel, resection of the internal preputial layer with lymphoedoma and resection of adjacent skin ventrally to symphisis in order to mobilize and enable free erection the penis was performed, split thickness skin grafts from the front surface of the thighs were removed by dermatome and fixed to all defects with polyglactine stitches. Grafts were healed, the patient is sexually active.

Conclusion:
The only therapeutic option and solution of advanced anogenital area HS in men is a radical surgery and a urologist should be informed of this possibility and according to the needs indicate it as early as possible.

Keywords: hydradenitis suppurativa, split thickness skin grafts

Received: July 22, 2011; Accepted: October 10, 2011; Published: September 1, 2011