EpistemisMass in the male anterior perineum
Specialty: Nephrology and urology.
Why it occurs
- Cowper's gland abscess (acute bacterial infection of the bulbourethral gland, which produces a painful mass located in the anterior perineum in front of the anal sphincter)
- Epidermoid cyst or perineal sebaceous cyst (benign skin lesion that can become secondarily infected)
- Post-traumatic perineal hematoma (sequela of trauma astride the perineum)
- Invasive scrotal or perineal carcinoma (rare skin malignancy)
- Urethroperineal fistula (sequela of urethral stricture or previous trauma with passage of urine and inflammation of perineal soft tissues)
Initial workup
Detailed perineal examination and digital rectal examination; high-resolution perineal and soft tissue ultrasound; CT of the abdomen and pelvis with contrast (test of choice to assess the extent of deep infections or abscesses in the anterior perineum); Voiding urethrocystography if urethral fistula is suspected.
red flags
Rapid appearance of a very painful, hot, erythematous anterior perineal mass, accompanied by high fever with chills, extreme difficulty urinating with urine retention, or bluish-violet skin color changes in the perineum (high suspicion of perineal necrotizing fasciitis or Fournier's gangrene).
Standard management
- Piperacillin/Tazobactam — 4.5 g every 6 hours intravenously) associated with Clindamycin (900 mg every 8 hours IV, indicated for the aggressive empirical treatment of deep necrotizing perineal infections before immediate surgical debridement
- Amoxicillin/Clavulanic — 875/125 mg every 8 hours orally if it is a successfully drained minor superficial abscess
- Urgent surgical debridement by urology if there is evidence of deep abscess or fasciitis.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Nephrology and urology
- Listed causes
- 5
- Treatment options
- 3