UROGENITAL TRAUMA

Management of penile fracture
El-Taher AM, Aboul-Ella HA, Sayed MA, Gaafar AA
Urology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
J Trauma. 2004; 56: 1138-40

• Background: Penile fracture is not a frequent event. It consists of rupture of the tunica albuginea of the corpora cavernosa. Fracture occurs when the penis is erect, as the tunica is very thin and not flexible.
• Methods: This prospective study was carried out over a period of 1 year and included 12 patients presenting with penile fracture.
• Results: Diagnosis was made clinically, and there was no need to perform cavernosography in any case. The most common cause of fracture was trauma to the erect penis during intercourse. Mean age of patients was 29.5 (+ /- 8.96) years, and mean time of presentation was 15.5 (+/- 8.04) hours. Subcoronal circumferential degloving incision was done in all cases. Nine patients were operated on, and three patients refused surgery and were treated conservatively. Repair consisted of evacuation of hematoma and repair of the tunical defect with absorbable sutures. The mean operative time was 33.9 (+/- 8.2) minutes. Preoperative and postoperative antibiotics were used, and all operated cases were discharged on the second postoperative day. All operated cases were able to achieve full erection with straight penis except one, in whom mild curvature and pain during erection was observed.
• Conclusion: Penis fracture is a true urologic emergency. It should be treated surgically as early as possible to ensure a better outcome.
  
  
• Editorial Comment
  This Egyptian study is a nice review that emphasizes the importance of prompt surgical repair for the management of penile fractures. Fractures that were repaired had no organic impotence and had straight, painless erections. Those who were managed conservatively developed penile nodules and plaques, and/or penile curvature and erectile dysfunction. Penile fracture is the result of axial forces to the erect penis that result in a tear in the tunica and/or Buck’s fascia of the penis. The tear in the fascia is typically transverse, involves the mid to proximal penis and is on ventral to lateral aspect. The tear can be close to or travel under the urethra, and in rare instances can extend into the corpus spongiosum or into urethra (partial or complete transactions). Patients with blood at the meatus or any degree of hematuria and penile fracture need to have the urethra evaluated for concomitant injury. This can be done preoperatively with a retrograde urethrogram or intraoperatively by flexible cystoscopy or by injecting blue-tinged saline retrograde and evaluating for extravasation. The diagnosis of penile fracture is based on history and physical examination. In rare instances, rupture of the dorsal vein can mimic a penile fracture. Otherwise, the diagnosis is often easy to make. Cavernosography is cumbersome, invasive, rarely ever performed, and generally unnecessary to make the diagnosis. In equivocal cases, magnetic resonance imaging may have a role in the diagnosis of penile fracture, since it is a noninvasive and sensitive and specific modality.

Dr. Steven B. Brandes
Associate Professor, Division of Urologic Surgery
Washington University in St. Louis
St. Louis, Missouri, USA