Here is an unusual case of penis tophi, proving that uric acid crystals will spread everywhere eventually. I have summarized a gout case study below, and there are many more in my tophi guidelines.
Tophi guidelines tell you all you need to know about gouty tophi, and here are the latest additions:
- Thumb Tophi – Worst Symptom of Thumb Gout
- Left Foot Tophi Study with Photographs
- Gouty Tophi In Finger Bone
- Best Tophi Picture
- Gouty Tophi & Bone Erosion
- Why are tophi important to gout sufferers?
Penis Tophi Report
This is my layman’s summary of a report from the University Hospital, Granada, Spain:
- Gouty Tophi in the Penis: A Case Report and Review of the Literature
- José Francisco Flores Martín, Fernando Vázquez Alonso, Ignacio Puche Sanz, Raquel Berrio Campos, Miguel Angel Campaña Gutierrez, and José Manuel Cózar Olmo
- Case Reports in Urology, vol. 2012, Article ID 594905, 3 pages, 2012. doi:10.1155/2012/594905
The author’s summary is:
Gout is a metabolic disease characterized by hyperuricemia and the deposition of monosodium urate crystals in different anatomical locations. We report the case of a 61-year-old man who received consultation for gouty tophi in the penis, which is an unusual location for this type of pathology, that was resolved with the surgical removal of the tophi. We provide a review on gout and its treatment as well as other locations where atypical gouty tophi have been described.
Penis Tophi Report: Introduction
Gout symptoms usually involve recurrent bouts of swollen joints and high uric acid in the blood leading to crystals forming in and around the joints. Gout patients often have lumps or tumors under the skin called gouty tophi.
The most common sites of tophi include the ears, elbow, knee, and the heal as well as under the skin of the hands, feet, and elbows. Tophi vary in quantity, size, and shape. They are yellowish-white in color with firm, smooth or ulcerated appearance and are, in most cases, highlighted on the skin [1, 2].
This report records the case of a patient with penis tophi, which the authors note is “an exceptional location for this condition.”
Penis Tophi Report: Case Presentation
A 61-year-old male had a history of high blood pressure and years of high uric acid and gout. He consulted for 4 small lumps on his inflamed penis that caused him pain during erection. The largest lump was 2.5 cm, suggestive of gouty tophi.
The patient also had similar lumps of various sizes on his hands, feet, and elbows, which were painless. He was treated with allopurinol and NSAIDs, but despite treatment, the lumps did not disappear. His uric acid blood test results were 9 mg/dL.
The tophi was removed surgically, and analyzed to confirm that it did contain uric acid crystals. The patient was without symptoms for 9 months after surgery.
Penis Tophi Report: Discussion
The report has 2 paragraphs describing the nature and incidence of gout [3, 5].
There are 4 forms of gout:
- High uric acid with no other symptoms (asymptomatic hyperuricemia)
- Regular gout with swollen painful joints (gouty arthritis)
- Gout in remission with no painful attacks (intercritical gout)
- Gout with visible lumps (chronic tophaceous gout)
This case is concerned with the last type, and the report describes the lumps. They are a mass of uric acid crystals surrounded by white blood cells. These white blood cells include the expected immune system cells, but also immature specialist cells. These specialist cells in healthy individuals are destined to repair and renew body tissues. 
Gout occurs after many years of high uric acid. Usually it starts with painful swollen joints. After about 5 more years, high uric acid leads to tophaceous gout.  Though usually around the ears and joints, tophi have been reported in other unusual locations. These include:
- Vocal cords
- Heart muscle
- Heart control (cardiac conduction system)
- Heart valves
- Spinal cord 
The report describes how tophi may be resolved by lifestyle improvements, but usually by uric acid lowering drugs. There may be reasons why surgery is necessary to avoid discomfort or immobility. [6, 8, 9] In this case allopurinol was not sufficient to reduce the tophi, so surgery was the answer. See other alternatives to surgery to remove tophi in the treatment for gout guidelines.
Penis Tophi: Next Steps
We can see that it is not sufficient to treat gout pain alone. We must control uric acid to prevent gout moving to the tophaceous stage. Once it has reached that stage, surgery is often required.
If you are worried about abnormal lumps, you must consult your doctor immediately. You can also discuss your tophi experiences in my gout forum.
Penis Tophi Report: References
- R. C. Landis and D. O. Haskard, “Pathogenesis of crystal-induced inflammation,” Current Rheumatology Reports, vol. 3, no. 1, pp. 36–41, 2001.
- K. N. Kelley, “Approach to the patient with hyperuricemia,” in Textbook of Rheumatology, W. N. Kelley, E. D. Harris, S. Ruddy, et al., Eds., pp. 1340–1347, W.B. Saunders, Philadelphia, Pa, USA, 2nd edition, 1985.
- M. A. Becker, “Hyperuricemia and gout,” in The Metabolic and Molecular Bases of Inherited Disease, C. R. Scriver, A. L. Beaudet, W. S. Sly, et al., Eds., pp. 2154–2155, McGraw-Hill, New York, NY, USA, 8th edition, 2001.
- R. A. Terkeltaub, “Gout,” The New England Journal of Medicine, vol. 349, no. 17, pp. 1647–1655, 2003.
- A. J. Luk and P. A. Simkin, “Epidemiology of hyperuricemia and gout,” American Journal of Managed Care, vol. 11, no. 15, pp. S435–S442, 2005.
- L. Feijóo Lamagrande, F. Gómez Bravo, F. Mayo Martín, et al., “Localización inusual de tofo gotoso: pirámide nasal,” Cirugía Española, vol. 67, no. 5, pp. 503–505, 2000.
- G. Navarrete Franco, B. Beirana Palencia, B. Bengoa Inzunza, A. M. Champet, and C. María Siu, “Tofos gotosos,” Rev Cent Dermatol Pascua, vol. 18, no. 3, pp. 92–95, 2009.
- A. J. Reginato, “Gota y otras artropatías microcrisltalinas,” in Harrison: Principios de Medicina Interna, D. l. Kasper, A. S. Fauci, et al., Eds., McGraw-Hill, Madrid, Spain, 16th edition, 2005.
- P. Arevalo, P. Briones, S. Enrique Loayza, and I. Enrique Uraga, “Frecuentes e inusuales localizaciones de tofos en la piel,” Revista Médica de Nuestros Hospitales, vol. 3–6, no. 14, pp. 27–30, 2009.
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