Diagnostic performance of MRI and US in suspicion of penile fracture

Abstract

Background: Penile fracture (PF) is defined as rupture of the tunica albuginea of the corpora cavernosa.While most authors agree that rapid surgical therapy of this rare pathology leads to the best patient outcome, the role of imaging is highly controversial in the published literature. To obtain further evidence concerning the diagnostic accuracies of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnostic assessment of patients with suspected PF. Methods: We systematically reviewed MRI and US examinations performed in our institution between 2000 and 2021 and correlated imaging reports with either intraoperative finding or final clinical diagnosis. Inclusion criteria were: (I) patient age ≥18 years, (II) examination between 2000 and 2021, (III) information available on patient's history and clinical presentation, and (IV) documented final diagnosis in discharge letter. Next to diagnostic accuracy, we describe typical imaging findings such as penile hematoma, tear of the tunica albuginea including location in terms of side and shaft segment affected, and involvement of corpus spongiosum.Results: Overall, 46 of 88 included patients (54.5%) had a confirmed diagnosis of PF. A total of 69 MRI and 31 US examinations were included. Sensitivity and specificity were 91.9% (95% CI: 78.7-97.2%) and 90.6% (95% CI: 75.8-96.8%) for MRI and 71.4% (95% CI: 45.4-88.3%) and 100.0% (95% CI: 81.6-100.0%) for US, respectively. Conclusions:The results of the present study suggest that MRI is more suitable to confirm PF and identify the site of the associated tunica albuginea tear while US is a good tool for ruling out PF.

Complications after surgical correction of penile fractures—Is there a clinical impact?

“…21 Transverse incision over the lesion has been gaining appeal, particularly when the lesion's exact location is identified via pre-operative imaging. 15 These techniques resulted in no differences in complications, that is, ED and self-satisfaction with body image. The validity of each technique is still debatable as circumcision is thought to contribute to sexual dysfunction after surgery in the form of penile hypoesthesia.…”

“…Ultrasound was used to aid clinical diagnosis in nearly two-thirds of our patients, while magnetic resonance imaging (MRI) was not used, despite its proven benefits. 15,16 MRI in the emergency department is not available in this context at our center.…”

“…Penoscrotal incision also offers these benefits without mobilizing the neurovascular bundle 21 . Transverse incision over the lesion has been gaining appeal, particularly when the lesion's exact location is identified via pre‐operative imaging 15 . These techniques resulted in no differences in complications, that is, ED and self‐satisfaction with body image.…”

Isolated rupture of the corpus spongiosum with urethral injury diagnosed by pre‐surgical MRI

“… 4 Spiesecke et al reported the sensitivity and specificity of US (71.4% and 100%) and MRI (91.9% and 97.2%). 5 However, US is highly dependent on the skill of the operator, while MRI is not relatively dependent on it. In Japan, MRI can be performed and is relatively easy and quick.…”

“…The AUA guidelines recommend consideration of MRI when US is inconclusive for PF 4 . Spiesecke et al reported the sensitivity and specificity of US (71.4% and 100%) and MRI (91.9% and 97.2%) 5 . However, US is highly dependent on the skill of the operator, while MRI is not relatively dependent on it.…”