Penile Fracture

Penile Fracture

Introduction

Penile injuries include

· Blunt trauma uncommon

· Gunshot wounds

· Stab wounds

· Avulsion injuries

· Strangulation

· Self-amputation

· Penile fracture

Aetiology of penile fracture: Eke N, Br J Surg 2002, 89, 555-565

· Review of all published cases 1935-2001

· 1642 cases reported in literature

· Age range 12-82 years

· Commonest in 4th decade

· Nearly half of all cases published from Mediterranean and muslim countries

Mechanism of penile fracture

· Usually during intercourse in West

· Penile manipulations in Middle East

· Patient attempting to correct chordae

· Erect penis into underwear

· Falling out of bed or rolling over

· Disentangling organ from garments

· Spontaneously whilst urinating

· Iatrogenic case reported during rectal surgery when penis caught between 2 leaves of operating table

Pathology

· Ventral distraction injury of erect penis

· One or both corpora fractured

· Tear in tunica albuginea dorsum or laterally mid-shaft

· Bruising and pain assoc with erectile deflation and inability to get further erection

· May be an associated urethral injury

Signs and symptoms

· History associated with intercourse

· Sudden cracking sound

· Penile pain and deflation

· Post-coital meatal bleeding

· Inability to void, dysuria or haematuria

· Swelling and ecchymosis

· Penile deviation

· Early on may palpate defect

· Egg plant deformity

· Blood at urethral meatus

· Late presentation: 
    ED 
    Penile deviation
    Peyronie’s like plaques 
    Urethrocavernous or urethrocutaneous fistulae

Management

· Clinical diagnosis - no benefit USS/MRI/cavernosography

· Urethrogram useful or flexible cystoscopy

· Operative management appropriate

· Degloving the penis +/- circumcision – can perform ventral approach

· Irrigate corporal space with saline

· Debride/freshen edges and close defect with vicryl

Prognosis

· Outcome very good after swift intervention

· In missed cases persistent erectile difficulties or high-flow priapism may occur

· High-flow priapism may improve with embolisation

· Un-diagnosed urethral injuries may result in stricture formation