What causes popping sensation in penis a day after penile plication surgery?

default
Posted on Fri, 19 Jun 2015 in Lump
Question: Hello. I underwent penile plication surgery for PD only a couple of days ago. The procedure was done with non-absorbable sutures and with no excision of tissue. My recovery had been going just fine, until this morning. My nocturnal erections have been quite strong the last couple of nights, and they have placed a great deal of tension on the internal sutures and the stitches around the circumcision line, causing much pain and discomfort. Now, early this morning, I awoke to a very hard and painful erection, and only seconds later there was an audible popping sound and an accompanying popping sensation in my penis. I began to see bruising around the site of where the sutures were presumably placed, and there was very mild pain/sensitivity in the area. I was deeply concerned that maybe the sutures had snapped and that the effects of the surgery would be undone, so I called my urologist immediately. When I saw him, he said he was convinced that the sutures could not have broken, as they are made from highly durable material. He believed that the bruising was from a burst blood vessel, and he wrapped me with a tight bandage. He could not, however, explain the popping sound/sensation that I experienced. Upon doing a little research afterwards, I discovered that the bruised area was over the superficial dorsal vein, and that superficial dorsal vein rupture might explain the popping sound and the bruising simultaneously. So, my questions:

(a) How unlikely is it really that these nylon sutures would break from the tension provided by a strong erection?
(b) If the sutures had broken for any reason, could this account for the subcutaneous bleeding?
(c) Could the popping and the bruising better be explained by superficial dorsal vein rupture?

Thank you.
doctor
Answered by Dr. T Chandrakant 1 hour later
Brief Answer:
Nylon is very strong, vein rupture causes big hematoma

Detailed Answer:
Hi.
Thanks for your query.
Read and understood your history of penile plication surgery for PD, erection, audible popping sound and popping sensation in the penis. Mild pain and bruising. Urologist convinced that the suture line is not broken and believes that the blood vessels busted.
To answer your queries:
(a) How unlikely is it really that these nylon sutures would break from the tension provided by a strong erection? > The tensile strength of the nylon suture is very good hence the breakage from the tension is most unlikely.

(b) If the sutures had broken for any reason, could this account for the subcutaneous bleeding? > If the sutures break, it will not cause the bleeding.

(c) Could the popping and the bruising better be explained by superficial dorsal vein rupture? > If the superficial Dorsal vein ruptures, the hematoma would have been very very big.

I was just wondering if you are taking some medicines like Amitryptilin to avoid the erection.

I hope this answers your queries.
Please feel free to ask further relevant queries if you need to or if you feel that there is a gap of communication.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. T Chandrakant 4 hours later
Hello,

Thank you for the prompt reply. No, I am not currently taking any medications to prevent erections. My surgeon did not seem to think it was important, and I understand that some doctors actually see some benefit for healing, despite the discomfort, of having erections early on. Either way, since it seems unlikely to you that the sutures may have broken, then I assume do you believe the symptoms to be consistent with a broken blood vessel? Although, I gather you don't think it could be the superficial dorsal vein? The hematoma is rather large, I'd say it covers about 1/4 to 1/3 of the skin on the shaft, but the swelling is more or less under control, although pain and sensitivity have increased significantly. Is this still inconsistent with a superficial dorsal vein rupture? If so, would a lesser blood vessel rupture explain the "pop" sound/sensation I experienced? The popping is really what concerns me and is what makes me still think it may have been the sutures breaking. So, my real follow up question is:

If my symptoms are inconsistent with a superficial dorsal vein rupture, but are still consistent with some sort of blood vessel rupture, could a smaller rupture still explain the popping noise/sensation I experienced?

Thank you.
doctor
Answered by Dr. T Chandrakant 5 hours later
Brief Answer:
Cut-through

Detailed Answer:
Hi.
Vein causing a rupture and the popping sound, not heard till now (30 years of practice), nor read till now in any reference. and does not looks coherent.

My explanation is:
What we call is cut-through:
Since the nylon thread used is thin and the stitches are put into the tunica albuginea, a very tough structure, the cut-through could have caused the popping sound and hematoma formation due to stretching.
This is usually partial and not to be bothered about.

Take medicines for reduced or no erections, or you may have next pop during next erection.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. T Chandrakant 48 minutes later
Thank you for your follow-up. Can you clarify a bit more what "cut-through" is? I'm assuming that the suture cuts into the tissue that it was constricting. If the suture cuts into the tunica, does it release tension and cause less reduction in curvature? You say that this is "usually partial". Does this mean that I could experience a "cut-through" and still not have any recurrence of curvature? Is it possible for there to be complete cut-through, thus entirely reversing the effects of the surgery? Also, can this cause further Peyronie's scarring?

Thank you.
doctor
Answered by Dr. T Chandrakant 9 hours later
Brief Answer:
as explained.

Detailed Answer:
You are most welcome.
Sure!
Cut-through is a surgical word we use when we tie a knot and the part of the tissue give way of the thread cuts through due to various reasons, particularly when the tissue is inflamed.
In your case the knotted thread is stationary but the erected penis is going to stretch the tissues under it causing a small part to get a cut through with resultant pop and hematoma.

I have tried to simplify, you may please ask for further explanation if you need to, I shall be happy to assist.

Now I would like to know you must have seen the erected penis, it is your judgment whether the straightening was maintained or not.

This is the importance of having some medicines for not allowing the erection to occur after such a surgery.
How the cut-through can have effect on the surgery and PD can not be predicted at the moment at all. Ideally it should not have such effect. You may please observe if there are any change in the curvature / straightening the next time you have erection.

It will not reverse the effects of surgery.

I hope this answer helps you, please feel free to give feedback, ask relevant further questions if you need to or if you feel that there is a gap-of-communications.

...
You may please rate this answer before closure of the discussion and can certainly contact me on the bellow link in future, whenever you may need me.
http://bit.ly/askdrtchandrakant
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. T Chandrakant

General Surgeon

Practicing since :1984

Answered : 13357 Questions

premium_optimized

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions
Medical Procedures
Medical Topics

Recent questions on  Tunica albuginea

doctor1 MD

So my pens be Bent And I know people say it's normal but when erect mines is at an 90 degree angle I've been worried about it what's wrong with me

doctor1 MD

Hello, i got a penis injury 2 months ago now i think, and it really scared me. I heard a popping sound, but there was no pain at all, no blood, no...

doctor1 MD

Hello, could you please explain how and why penile length is lost because of peyronies disease. And when they talk about loss after surgery does...

doctor1 MD

Hi, 43 yr old male on Aug 2012 MRI Pelvis w/focus on the penis was performed with and without IV contrast. Findings: there are 3 soft tissue...

doctor1 MD

this has been happening to me for about 2 weeks now my first symptom was a hard like lump under skin at the base of my penis and about 2 inches up...

doctor1 MD

Hi. I woke up with an erection, and when I tried to fold it down it my penis made a popping sound. Now my testicles are almost 3x the normal size,...

doctor1 MD

Hello...I am a male of nearly 40 and have never had problems in sexual nature but last night had some sex in a doggy style position and as we were...

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
backtotop2