Urology

Prepared by Keith L. Lee, MD, Chief Resident, Stewart W. McCallum, MD, Assistant Professor, and Christopher K. Payne, MD, Associate Professor, Department of Urology, Stanford University Medical Center, Stanford, Calif.

A 47-year-old man presented with a 2-day history of acute penile swelling, pain, and redness. He reported a zipper entrapment injury to the shaft of the penis as the initial cause. His symptoms progressed slowly, until 6 hours before presentation, when rapid swelling and severe pain spread to the scrotum. He denied any dysuria, hematuria, urinary symptoms, or fevers.

Physical examination revealed blanching erythema and tenderness on the penile shaft (Figure 1). Laboratory test results, including urinalysis, were within normal limits. The patient's history included hepatitis C virus infection but no diabetes or immunosuppression.

What's Your Diagnosis?

• Eczema
• Candidiasis
• Fournier's gangrene
• Abscess

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