Penile fracture and associated urethral injury: Experience at a tertiary care hospital

Abstract

Introduction: Penile fracture may be associated with urethral trauma in 1% to 38% of cases. We present our experience in treating 8 such cases. Methods: Data were collected retrospectively from hospital records and from out-patient department follow-up visits. Results: The mean age of the patients was 30.4 years; trauma during coitus was the most common cause of the penile fracture. One patient presented after 7 days. Two patients had normal examination of their penis despite typical history. All fractures were repaired on an emergency basis via subcoronal incision. In 2 patients with normal findings, the urethra had to be mobilized to locate the site of the injury. In 1 patient, the site of the urethral trauma was 1 cm away from the site of the corporal injury, which was localized by injecting sterile methylene blue per urethra. Postoperatively, all patients voided with good flow and had erections with adequate rigidity. Conclusion: A high level of suspicion for urethral injury during surgical exploration is warranted, especially in the presence of suggestive history and examination. IntroductionPenile fracture occurs when the erect penis is forcibly bent against resistance leading to a rupture of the corpora cavernosa.1 A history and clinical examination are the most important tools to diagnose penile fracture. Typical clinical presentation includes a snapping sound during the sexual act followed by immediate pain and penile detumescence, in addition to the emergence of large edema, hematoma and penile deformity.2 It may be associated with urethral trauma in 1% to 38% of cases.3,4 Associated urethral injury should be suspected if there is blood at meatus, hematuria and difficulty in voiding.On examination, there is localized penile swelling with deviation to the opposite site. Careful palpation reveals a firm hematoma overlying the corporal defect on which penile skin can be rolled (or "rolling sign"). Extravasation outside the Buck's fascia can lead to a butterfly shaped hematoma in the perineum. 2We present our experience with 8 cases of penile fracture with associated urethral injury that were treated at our hospital. MethodsA total of 34 cases of penile fracture were seen at the hospital emergency from July 2005 to July 2011. Out of these 34 patients, 8 had associated urethral injury. Data were collected retrospectively from hospital records and during out-patient department follow-up visits. An effort was made to keep all patients in active follow-up in the urology outpatient department.All cases were explored on an emergency basis. Subcoronal incision was used in all cases with complete degloving of penis. Absorbable suture (polyglactin 4-0) was used for repair after refreshing the margins. All patients were catheterized with a 16 Fr Foley catheter intraoperatively.All patients were discharged with instructions to continue antibiotics and estradiol 0.05 mg orally to prevent postoperative painful erections for 3 weeks. The indwelling urethral catheter was removed after the pericatheter contrast st...

Mechanisms Predisposing Penile Fracture and Long-Term Outcomes on Erectile and Voiding Functions

“…Although imaging may be required for better evaluation, usually it is unnecessary [ 3 ]. Urethral bleeding and voiding incapacity can be an alert to urethral injury and a retrograde urethrogram should promptly be requested to optimize treatment planning with simultaneous urethral repair during surgery [ 4 ].…”

Diagnosis and Treatment of Penile Fractures: A Single Center Series

“…Concomitant urethral injury is reported in 10% -33% of penile fractures and patients often present with hematuria and voiding difficulties [12], but absence of these symptoms does not exclude urethral injury [13]. In our series a urethral injury was seen at operation in one patient who didn't have hematuria at presentation.…”

Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters

“…Urethral injury can be seen in approximately 1-38% of penile fracture [19]. Penile fracture refers to rupture of corpus cavernosa with tunica albuginea tear, usually as a result of rapid blunt trauma to the erect penis.…”

“…RUG is recommended in these cases, albeit it may be false negative in 28% of cases due to tamponade by hematoma [20]. Many urologists prefer direct visualization of urethra during penile fracture repair or urethroscopy [19]. Alternate option RUG shows urethral disruption with contrast extravasation into the corpus spongiosum.…”