Surgical excision of perineal nodular induration: A cyclist's third testicle

Mohannad A. Awad, Gregory P. Murphy, Thomas W. Gaither, E. Charles Osterberg, Thomas A. Sanford, Andrew E. Horvai, Benjamin N. Breyer

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Perineal nodular induration (PNI), or biker's nodule, is a rare, bothersome, pseudotumour. Herein, we describe the surgical technique used to treat a healthy cyclist who developed an enlarging PNI for five years that grew into a perineal mass. The mass prevented him from cycling due to worsening discomfort and heaviness. The PNI-associated mass was successfully removed by wide surgical excision and a local advancement flap. Subsequently, the patient resumed cycling. Histopathology report demonstrated a benign lesion with abundant ropy collagen with native smooth muscle, vessels, and rare fibroblast-like spindle cells. With the increasing popularity of cycling, PNI may become more common, and health providers should be aware of this rare entity and how it can be safely removed.

Original languageEnglish
Pages (from-to)E244-E247
JournalJournal of the Canadian Urological Association
Issue number5
StatePublished - May 2017


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