Dorsal Vein Injuries Observed During Penile Exploration for Suspected Penile Fracture

Abstract

Introduction Penile fracture is a rare injury, bearing potential impairment of erectile function if not treated. Patients with clinical presentation of a penile fracture commonly undergo early surgical exploration with the intention to repair a tunica albuginea tear. Aim We present a group of men who presented with a penile hematoma following trauma to the erect penis. Exploration revealed an intact tunica albuginea and a dorsal vein tear. Methods Eighteen men (mean age 38 years, range 20–55) presented with suspected penile fracture during an 8-year period. One man presented twice. Two of the patients were managed expectantly and the remaining 16 patients underwent 17 immediate surgical explorations. Explorations were performed under general anesthesia, using a circumferential subcoronal incision and degloving of the penile skin. The tunica albuginea of both penile sides as well as the penile urethra were examined for injuries. Main Outcome Measures Medical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function, medical treatment for erectile dysfunction, and penile curvature were obtained during follow-up. Results In nine of the 17 procedures the tunica albuginea was intact and the only pathological finding was a ruptured dorsal vein. One procedure was negative for both tunical and vascular injury. A tunical tear was detected in the remaining seven procedures. At a mean follow-up of 40 months (range 4–91), five patients required medical treatment for erectile dysfunction, including the two who were managed expectantly, two with a tunical tear, and one with a venous tear. Conclusions Dorsal vein tears may mimic penile fracture. Suggestive findings following trauma to the erect penis prompted exploration for suspected tunica albuginea tear. In less than half of the men was the diagnosis of penile fracture established and treated at surgery.

Isolated rupture of the superficial vein of the penis

“…Even though there are no large cohorts to provide data on dorsal penile vein rupture and the associated risk factors, BarYosef and colleagues have described their experience with 9 patients. 3 They suggested that circumcision could be one of the risk factors for dorsal vein rupture due to stretching of the penile skin during intercourse. Similarly, Baran and colleagues concluded that circumcision could have been the mechanism of injury in their patient with superficial penile dorsal vein rupture after surgical exploration.…”

“…Most patients with penile fracture would report hearing a "snap" sound, which is followed by pain, penile detumescence, and late appearing swelling, hematoma and penile deformity. 3,4 When there is associated urethral injury, we sometimes notice concurrent urethral bleeding, difficulty voiding and hematuria. 5 However, patients with rupture of the superficial dorsal vein of the penis may not describe the classic "snap-pop" or rapid detumescence.…”

Penile fracture

“…On the other hand, Mydlo et al [ 1 ] found that the cavernosographic fi ndings were falsely negative in two of seven patients with penile fracture, suggesting a possible ball-valve effect of the underlying hematoma. BarYosef et al [ 12 ] reported the high incidence of dorsal vein injuries observed during penile exploration for suspected penile fracture. The results of that study showed that in 9 of 17 operations, the tunica albuginea was intact, and the only pathologic fi nding was a rupture of the dorsal vein [ 12 ].…”

“…BarYosef et al [ 12 ] reported the high incidence of dorsal vein injuries observed during penile exploration for suspected penile fracture. The results of that study showed that in 9 of 17 operations, the tunica albuginea was intact, and the only pathologic fi nding was a rupture of the dorsal vein [ 12 ]. These results are important in regards to the use of additional techniques for the diagnosis of penile fracture.…”

Fracture penis with urethral disruption & scrotal hematoma: A case report

“…2 Many conditions can simulate fracture penis as dorsal vein tears in penis may mimic penile fracture. 3 …”