LAUSR

We present a unique case of a patient with a giant bilateral inguinoscrotal hernia associated with a basaloid carcinoma in pennis. A 60 year old male with bilateral inguinoscrotal hernia came to our office because he had a suppurative ulcer around pennis and chronic hidradenitis in perineal and scrotum region. We presented the case in a multidisciplinary session composed by urologists, plastic surgeons and abdominal wall surgeons in order to plan the diagnosis and treatment. The CT showed us a bilateral inguinoscrotal hernia with a large and small bowel inside them. The multidisciplinary team decided on toxin botulinum. An infiltration previous hernia repair in order to avoid complications related to the huge volumen. During the infiltration we also scheduled cystoscopy and biopsy of the pennis injury. The cystoscopy showed a urethral fistula. The biopsy was informed as a basaloid invasive carcinoma. Surgery was scheduled 4 weeks after toxin botulinum infiltration. Surgical team was composed of urologists, plastic surgeons and abdominal wall surgeons. We performed a hypogastric transverse incision, then opened midline to reduce inguinal hernia contented by a combined maneuvers. Small bowel resection was performed because it was infiltrated by the tumor. Bilateral Liechtenstein repair was done with polypropylene mesh. The midline was closed with intra abdominal mesh and continuous suture. Partial penectomy was done. Scrotum skin was resected. Testicles are left in, in a crossing mode under skin flaps. Anatomopatologic diagnosis was Pennis Epidermoid carcinoma pT3pN0 pM1. After 1 year follow up no recurrence of tumor or hernias.