Penile Fractures

[madman]

INTRODUCTION

Penile fracture is a urologic injury defined as the disruption of the tunica albuginea with rupture of the corpus cavernosum, usually occurring as blunt trauma to the erect penis during intercourse.1 Although penile fracture is a clinical diagnosis using history and physical examination, imaging is evolving as a helpful adjunct. Immediate surgical management is the standard of care per AUA and EUA guidelines.2,3




*EPIDEMIOLOGY

*PRESENTATION

*DIAGNOSIS

*MANAGEMENT AND OUTCOMES




SUMMARY

Penile fracture is a urologic injury with an etiology that varies based on the cultural milieu. Diagnosis can be made based on history and physical examination alone. Patients should be evaluated with RUG or cystoscopy when a urethral injury is suspected. Ultrasound or MRI is a helpful adjunct when the diagnosis is unclear and can assist in identifying the location of the rupture. Surgical management is favored over conservative measures to improve outcomes. Delayed surgical repair may not be inferior to immediate intervention.

 

[madman]

Fig. 1. A 50-year-old man presenting after penis hit tailbone during sex, causing acute pain, a loud snap, and rapid detumescence; voiding a small amount of bloody urine.

 

[madman]

Fig. 2. Diagnosis of penile fractures can be made with a careful history and physical examination. However, imaging can be useful in certain clinical scenarios.

 

[madman]

Fig. 3. Retrograde urethrogram concerning for concomitant penile urethral injury.

 

[madman]

Fig. 4. Ventral midline penoscrotal incision provides excellent exposure, allowing the penile fracture (blue arrow) and concomitant urethral injury (green arrow) to be identified.

 

[madman]

Fig. 5. Repair of the tunical defect, and closure of urethral defect over catheter.

 

[madman]

KEY POINTS

*Penile fracture is a urologic injury with unique etiologies depending on geography and culture

*Diagnosis of penile fractures can be made based on history and physical examination alone, but ultrasound or MRI can be helpful adjuncts

*Patients should be evaluated with retrograde urethrogram or cystoscopy when a urethral injury is suspected

*Surgical management is favored over conservative measures to improve outcomes

 

[madman]

CLINICAL CARE POINTS

*Penile fractures require urgent urologic evaluation

*Diagnosis should be promptly made with a careful history and physical exam

*Imaging to aid in the diagnosis can be considered when the diagnosis is unclear

*Immediate surgical exploration remains the standard of care