Penile Fracture: Injury of the Penis Corpora
Traumatic rupture of the corpora of the penis during erection is called a penile fracture (Sawh et al, 2008).
Epidemiology of Penile Fracture
Very rarely, 1 of 175.000 hospital admissions.
Etiology of Penile Fracture
Penile fracture usually arises from a bending trauma during vigorous sexual intercourse, especially when the penis slips out of the vagina. Furthermore, penile fractures are caused by masturbation practices with bending of the penile shaft during erection (practice of taghaandan).
Signs and Symptoms
Patients report a traumatic bending of the erect penis, often with a cracking noise. Typically, a sudden detumenescense occurs and a massive penile hematoma develops. A defect in the tunica albuginea may be palpable.
Complications of Penile Fracture
- Hematoma infection and abscess formation
- Urethral injury
- Urethral stricture
- Penile instability with erectile dysfunction
Diagnosis of Penile Fracture
When patients present the typical signs and symptoms, a surgical exposure of the penile shaft is justified without further diagnostic work-up. When the diagnosis is uncertain, following imaging studies are recommended.
Penile Ultrasound Imaging
Penile ultrasound imaging with a 10 MHz transducer may show the defect of the tunica albuginea [fig. ultrasound imaging of a penile fracture
]. It is not reliable enough for the exclusion of the diagnosis.
|Ultrasound diagnosis of a penile fracture (left perpendicular and right longitudinal axis to the penile shaft): in both axis the defect of the tunica albuginea with hematoma is visible.|
Cavernosography of the penis can reliably exclude a penile fracture in doubtful cases. Cavernosography is not necessary with typical signs and symptoms.
Magnetic resonance imaging can reliably demonstrate the localization of the penis fracture or exclude the diagnosis [fig. MRI imaging of a penile fracture].
|MRI of a penile fracture (on the left horizontal and on the right frontal recontructions): the defect is visible at the right corpus cavernosum. With kind permission of Prof. Dr. K. Bohndorf, Augsburg.
Differential Diagnosis of Penile Fracture
Acute subcutaneous bleeding through a venous tear can be confused with a penile fracture.
Treatment of penile fracture
Prophylactic antibiotics are recommended in surgical and conservative therapy of the penile fracture.
Surgical Treatment of penile Fracture
Emergency surgery is probable not necessary, since elective operations have equal good results (el-Assmy et al, 2011). A urethral catheter is inserted before operation. A circumcising incision is used to approach the penile shaft is the location of the rupture is not clear before the operation. Alternatively, direct incision at the fracture location is possible, when preoperative imaging is reliable. The tunica albuginea is sutured with absorbable sutures (2-0 or 3-0). Care is taken to identify and suture a urethral injury, the urethral catheter should be left for 3&ndash,7 days depending on the severity of urethral injury. A circular dressing prevents further swelling after skin closure.
Care after surgical therapy: antiandrogens (e.g. bicalutamide 50 mg 1-0-0 for two weeks) or benzodiazepines help against painful erections. Sexual abstinence is recommended for one month.
Conservative Management of Penile Fracture
Initial bed rest, antiandrogens (or benzodiazepines) against erections, cooling of the penis and circular dressings are the mainstones of conservative therapy. Conservative treatment leads to more complications than surgical therapy: penile deviation, penile pain, massive hematomas, persistent swelling and diverticula of the penile corpora.
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