Dermatology Online Journal

Vascular malformation of the glans penis succesfully treated with Nd:YAG laser
Verónica López MD, José M Ricart MD, Inmaculada López MD, José M Martín MD, Davide Marton MD, Carmen Ortega MD, Salvador Costa MD
Dermatology Online Journal 18 (10): 16

Dermilaser, Hospital Quirón Valencia, Spain

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Abstract

Penile venous malformations are uncommon and those located on the glans are even rarer. Treatment of venous malformations of the glans is currently controversial. Neodynium (Nd):YAG laser treatment may be a useful option.

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Penile venous malformations are uncommon and those located on the glans are even rarer [1, 2, 3, 4]. Treatment of venous malformations of the glans is currently controversial. Neodynium (Nd):YAG laser treatment has been reported to be effective and safe. However, it is associated with a high risk of scarring and a high incidence of recurrence. Sclerotherapy has recently been reported as another good option in the treatment of vascular malformations and has provided excellent esthetic and functional results even for lesions located on the glans. We report a case of glans penis vascular malformation that led to erectile dysfunction and which was successfully treated with Nd:YAG laser.

Figure 1	Figure 2
Figure 1. Extensive vascular malformation involving glans and distal part of prepuce. Figure 2. A residual small scar depression was seen on follow-up.

A 28-year-old male was seen in the dermatology out-patient clinic with a lesion on the glans penis present since childhood. His past medical history was unremarkable. On physical examination, a 15 mm, blue, compressible nodule on the left dorsolateral part of the glans penis was observed (Figure 1).

A painful deformation could be seen during erection. Magnetic resonance imaging revealed a vascular malformation. Ultrasonographic examination confirmed the presence of a low flow vascular malformation.

Before admission to our clinic, a surgical treatment of the lesion, which was refused by the patient, was recommended. Treatment with Nd:YAG laser fiber (Vantage Cutera Altus®) was performed under penile topical anesthesia with lidocaine cream. The first treatment was performed with a radiation energy 60 joules in the pulse, a pulse duration of 40 msec, and a light spot diameter of 7 mm. One month later, a second treatment was performed at a power setting of 110 joules in the pulse, a pulse duration of 20 msec, and a light spot diameter of 5 mm.

Topical oxytetracycline clorhydrate plus polymyxin B sulfate cream was applied once a day for 10 days immediately after the procedure. The postoperative period was quite comfortable for the patient. The wound healed completely after 10 days with a slight scar depression. One year after laser treatment no recurrence was observed (Figure 2). Moreover, erectile dysfunction resolved after laser treatment.

Vascular malformation of the penis and scrotum are very rare and scarcely reported; those located on the glans penis are even more infrequent. Typically, vascular malformations appear as a faint blue patch or a soft blue mass. There is no increase in local temperature and they can be easily compressed by applying pressure. The lesions slowly worsen and may often increase in size during childhood.

Many theories have been proposed to explain the etiology. Some investigators suggest that a penile venous malformation should be considered a congenital vascular anomaly or a benign vascular neoplasm [5]. Others believe that it could be produced by herniation of the cavernous body tissue [6] or that it could grow through the revascularization of a previous penile hematoma [1]. Although some lesions continue to grow, no treatment is usually required unless desired for cosmetic reasons or if associated symptoms are present.

Therapeutic options include surgical therapy, electrofulguration, and cryotherapy [7]. Poor healing and scar formation are frequent complications of surgery of the glans penis.

In this case, besides aesthetic considerations, a significant improvement of erectile dysfunction was appreciated after Nd:YAG laser treatment. Thus, Nd:YAG laser could be a useful therapeutic option in order to improve healing and avoid more aggressive procedures. The minimal morbidity associated with this technique and the absence of recurrence may lead one to consider Nd:YAG laser as a useful treatment for venous malformation of the external genitalia.

References

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2. Senoh K, Miyazaki T, Kikuchi I, et al. Angiomatous lesions of glans penis. Urology 1981; 17: 194-196. [PubMed]

3. Khanna S. Cavernous haemangioma of the glans penis. Br J Urol 1991; 68: 332. [PubMed]

4. Jimenez-Cruz JF, Osca JM. Laser treatment of glans penis hemangioma. Eur Urol 1993; 24: 81. [PubMed]

5. Dehner LP, Smith BH. Soft tissue tumors of the penis. A clinicopathologic study of 46 cases. Cancer 1970; 25: 1431-47. [PubMed]

6. Mortensen H, Murphy L. Angiomatous malformations of the glans penis. J Urol 1950; 64: 396-9. [PubMed]

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