Penile fracture: second episode in 5 years

Abstract

Penile fracture: second episode in 5 yearsPenile fracture is a rare condition, accounting for 1 in 175 000 emergency presentations. 1 The most common cause is trauma during sexual intercourse, whereby the erect penis strikes the pubic symphysis or perineal body. It can be managed either surgically or conservatively. Gamal et al. reported 96% of patients treated with acute surgical repair achieving an erection adequate for intercourse, with no voiding dysfunction and no penile curvature versus 50% of those managed conservatively at a median follow-up of 20.8 months. 2 This result is consistent with other published series; however, there is only one other report of a patient who has had two penile fractures in the literature to date. 3 This is a rare case where a patient presented with his second penile fracture in 5 years and underwent acute surgical exploration and repair on both occasions.A 48-year-old man, previously well, non-smoker, presented to the emergency department with a painful, swollen penis. He describes having slipped during sexual intercourse 2 h prior and heard a 'popping' sound. The penis then became flaccid and swollen. He was still able to void without macroscopic haematuria. Clinically, the penis was deviated to the left with haematoma over the right ventral penile shaft. The patient was taken to theatre for an acute exploration.Five years ago, the patient had suffered a penile fracture via a similar mechanism. He underwent an acute exploration through a circumferential, sub-coronal incision, and a horizontal defect in the left corporal cavernosum was repaired.On this occasion, a 16Fr catheter was inserted with ease intraoperatively. The previous incision was used, and upon mobilization of the corpora spongiosum and right corpora cavernosum, it became clear that there was a longitudinal defect in the right corporal cavernosum ventro-medially, which required lateral retraction of the urethra to allow full visualization. The haematoma was then evacuated and defect was closed with simple, interrupted, inverted absorbable sutures.Post-operative recovery was unremarkable and he was discharged 2 days later. At the first follow-up visit 6 weeks later, there was good healing, and spontaneous erections to allow completion of intercourse with minimal penile curvature (see Fig. 1).This case reinforces the argument that acute exploration and repair is the gold standard treatment for penile fractures and is associated with highly successful and functional outcomes, even in the setting of a second penile fracture. References 1. Miller S, McAninch JW. Penile fractures and soft tissue injury. In: McAninch JW (ed.).

Penile refracture: a preliminary report

“…All patients underwent the standardized surgical technique in our institution, as previously described ( 4 ), which consists of penile degloving through subcoronal incision. In this access, lesions of the corpora cavernosa are identified and the tunica albuginea is sutured with separate stitches of 3 - 0 Polyglactin.…”

“…The occurrence of a second episode of PF consists of an even rare situation, with only 10 cases described in the world literature ( 4 – 13 ). The aim of this study is to evaluate the demographic data, recurrence time, etiology and operative findings in the first and second episodes.…”

Recurrent Penile Fracture—Case Report and Alternative Surgical Approach

“…As previously discussed, reports in the literature include RF at the contralateral CC, 4 , 5 ipsilaterally at a new site, 6 , 7 and ipsilaterally at the same site. 8 , 9 Cases of same-site fracture, similar to the present case, foster the concept that, despite a complex healing process, final tissue resistance never reaches that of unwounded tissue.…”

“…Recurrent PF is an exceedingly rare event, with very few reports in the literature. Recurrences can occur at different locations, including contralaterally, 4 , 5 ipisilaterally, 6 , 7 and at the same site. 8 , 9 This is, to the best of our knowledge, the 1st report of recurrent PF with 3 same-site recurrences.…”

A case of repetitive penile fracture: an increasingly observed phenomenon

“…Our literature review identified only nine cases of repetitive penile fractures. Seven of these repetitive fractures occurred on the ipsilateral corpus cavernosum, with just two cases occurring on the contralateral corpus 4,5,6,7,8,9,10,11,12 . An ipsilateral re-occurrence would suggest a fibrous scar liable to fracture on further insult, or possibly that the fibrous scar created a weaker contiguous tunica fascia prone to buckling when erect, and at pressures inferior to the usual stresses required to rupture normal albuginea.…”