Penile Sonography: Benefits of clinical input with difficult cases

Karen Lau, Stephen Wolstenhulme, Roger Lapham, Oliver Hulson, Leeds Teaching Hospital


Penile sonography is an accessible and invaluable diagnostic tool in characterising lesions, identifying fractures and assessing functional vascularity. It is technically straightforward but the interpretation of penile lesions can be difficult. This pictorial review aims to demonstrate educational points from two cases regarding a superficial and a deep penile lesion and the crucial benefit of involving the referring clinical team in aiding the diagnosis.

Case Discussion

Case one:  A young man who presented with a smooth and mobile lump on the mid-shaft of the penis for the last six weeks. Clinical diagnosis:  superficial cyst. Sonography demonstrated an hypoechoic ellipsoid lesion on the dorsum of the penis; possibly arising from the glans. Foreskin retraction was not performed; may differentiate the lesion from the skin or the glans. Follow up is ongoing.

Case two:  A young man who presented with penile discharge and a history of phimosis with a clinical suspicion for penile abscess. Sonography requested to help differentiate whether the abscess was superficial or deep; to determine the patient’s medical or surgical management respectively. The patient had two scans over two days. First scan reported as a left corporal abscess involving the glans. The clinical team felt the abscess was deeper and a second scan was done with a urologist on site to demonstrate where the abscess was felt clinically. Repeat sonography confirmed a penile abscess in the deep tissue of the corpora cavernosa without foreskin and superficial tissue involvement.


These two cases demonstrate the diagnostic dilemma of performing and interpreting penile sonography. The first demonstrates a scenario whereby technique (i.e. retraction of foreskin) may have altered lesion characterisation. The second highlights the importance of clinical input from the referring team. The lessons from these cases may prove to be useful in improving the quality of penile sonography.

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