REVOLUTIONARY TREATMENT OF PENILE KELOID AFTER CIRCUMCISION: A COMBINED APPROACH WITH BRACHYTHERAPY AND HYPERBARIC OXYGEN THERAPY WITH SURGERY

REVOLUTIONARY TREATMENT OF PENILE KELOID AFTER CIRCUMCISION: A COMBINED APPROACH WITH BRACHYTHERAPY AND HYPERBARIC OXYGEN THERAPY WITH SURGERY

M. Firat OZERVARLI 1, Ismail SELVI 1, M. Irfan DONMEZ 1, Nezihe Seden KUCUCUK 2, Tayfun OKTAR 1 and Orhan ZIYLAN 1
1) Istanbul University Istanbul Faculty of Medicine, Department of Urology, Fatih/İstanbul, TÜRKIYE - 2) Istanbul University Istanbul Faculty of Medicine, Department of Radiation Oncology, Fatih/İstanbul, TÜRKIYE

PURPOSE

Keloid formation along the incision line is a very rare complication of circumcision. Various treatments, including surgery, radiation, topical corticosteroids, and intralesional triamcinolone injections, have been used, but no standardized protocol exists. Half of the cases may recur within 6-12 months. On the other hand, brachytherapy has gained popularity in recent years as an adjunctive treatment due to its high recurrence-free survival rates in keloid scars.

This case report discusses the novel use of brachytherapy+hyperbaric oxygen therapy in conjunction with surgery for a child with a recurrent circumcision line keloid.

MATERIAL AND METHODS

An 11-year-old male with no co-morbidities presented with recurrent keloid formation along his circumcision incision line. He had undergone circumcision at age 2 and developed a keloid two months later. Despite two surgical keloid excisions at ages 6 and 8, recurrence occurred within 3 months after both surgeries. His examination revealed a large circular keloid extending from the coronal sulcus to the penile shaft. No other urological abnormalities were found.

RESULTS

During excision, six brachytherapy tubes were placed—three on each side of the corpus cavernosum. Brachytherapy started within 24 hours, delivering 2.5 Gy over two days in four fractions. The patient also received 20 days of hyperbaric oxygen therapy of which each session lasted 120 minutes (with 5-minute breaks every 20 minutes) at a pressure of 2.4 ATA (1 ATA = 760 mmHg).

At the 8-month follow-up, there was no recurrence, and the incision line appeared natural.

CONCLUSIONS

Keloid formation along the circumcision incision line is rare and has a high recurrence rate despite various treatments. In this case, a combination of brachytherapy, hyperbaric oxygen and surgical excision led to complete regression, with no recurrence at 8 months.