Urogenital Trauma

Abstract

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 injuries are not really urethral strictures, and thus minimally invasive methods and "cut to the light" procedures do not have any durable success.

Penile Fracture: A Meta-Analysis

“…This would appear to be more prevalent in Eastern cultures than Western ones. It has previously been suggested [11] that the ‘woman on top' position is more likely to result in penile fracture, but meta-analysis of 5 studies [3,15,19,24,62] did not find this finding to be significant (p = 0.59).…”

“…There were no randomised trials and all studies were observational and generally of low quality. Only one study was prospective [11] with the remaining 57 being retrospective [1,2,3,5,8,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62]. Twenty studies made direct comparisons between conservative and surgical management [5,11,12,13,15,19,20,21,25,31,36,38,39,40,42,43,47,51,55,59].…”

“…Three studies used absorbable and non-absorbable on a case-by-case basis [5,37], 25 studies used only absorbable [1,2,11,14,15,16,17,20,21,25,27,31,35,36,39,40,42,43,44,46,49,53,58,59,62], 4 used only non-absorbable [8,13,48,52] and 18 did not specify the type of suture material used [3,12,18,19,22,23,26,28,29,30,32,34,38,45,47,50,51]. …”