Penile Fracture With Urethral Bleeding: A Urological Emergency

Abstract

Erection transforms the penis from a safe, flaccid organ to a susceptible one. During an erection, the thick tunica albuginea thins and becomes fracturable. Penile fracture (PF) is a very uncommon ailment produced by a blow to the erect penis. Unphysiological bending of the erect penis during sexual activity or masturbation is the most often reported mechanism of trauma. The penis is made up of three columns of erectile tissue: one ventral corpus spongiosum and two dorsolateral corpora cavernosa, each enclosed by the tunica albuginea. The tunica albuginea is a bilaminar structure composed of collagen and elastin. The outer layer of the tunica determines its strength and thickness. It varies in several locations across the shaft and is thinnest ventrally. It has high tensile strength and can sustain rupture at intra-cavernous pressures of up to 1500 mmHg. The tunica albuginea's thickness decreases from 2 mm to 0.25 mm while the penis is erect, and a trauma-induced rise in intracorporeal pressure during an erection might easily cause rupture. PF with urethral bleeding is a very rare urological emergency. One of the common causes of PF includes vigorous sexual intercourse. Symptoms include a cracking, snapping, or clicking sound followed by an instantaneous detumescence. Additionally, the penis may exhibit acute discomfort, significant ecchymosis, rapid swelling, and noticeable eggplant deformity. This is a case report of a 30-year-old male who presented with a history of penile swelling and ecchymosis during sexual intercourse. There was blood spotted at the urethral meatus. A retrograde urethrogram showed complete disruption at the proximal third of the urethra. The patient was immediately taken for surgery, and extensive exploration was done. There was a significant defect of the tunica albuginea of the corpora cavernosa on the ventral side of the penis. Along with the defect and the PF, there was a sizeable urethral injury as well. The defect of the tunica albuginea of the corpora cavernosa was repaired with a Prolene 2.0 suture (Johnson & Johnson, New Brunswick, New Jersey, United States), and urethral reconstruction was done with Vicryl 3.0 interrupted suture (Johnson & Johnson, New Brunswick, New Jersey, United States) over a 14-Foley catheter. Ultrasonography (USG) can be used to assess patients who have suffered penile injuries as well as to determine the sort of incision that is necessary, saving time by preventing needless waiting. This instance emphasises the value of early diagnosis in cases of unique presentation and early surgical treatment for improved results.

Beyond the Breaking Point: A Unique Case Report of a Penile Fracture With a Distal Urethral Injury

“…Complications of penile fractures can be significant and long-lasting even after surgery. Erectile dysfunction is a common complication and can result from damage to the neurovascular bundle or fibrosis of the corpora cavernosa [ 9 , 10 ]. Penile curvature or deformity can also occur, which can affect sexual function and lead to psychological distress.…”

“…Penile curvature or deformity can also occur, which can affect sexual function and lead to psychological distress. Urethral stricture, secondary to urethral injury, is another potential complication that can cause urinary symptoms and require further intervention [ 9 , 10 ].…”

Isolated Penile Fracture and Complete Urethral Injury After a Motorcycle Accident: A Case Report and Literature Review

“…PF is a rare urological emergency that must always be treated immediately. Between 9% and 20% of PF cases also present with urethral injury, particularly in patients with urinary symptoms, such as urine retention and urethral bleeding [ 3 ]. The incidence of associated urethral injury is significantly higher (20%-25%) in the Western world compared to Asian countries (3%-6%) [ 4 ].…”