Penile fractures: immediate surgical approach with a midline ventral incision

Abstract

OBJECTIVES To present our experience with immediate surgical treatment of penile fractures, using a midline ventral incision, as the choice of either immediate surgical or conservative treatment in penile fractures, as well as the type of surgical incision, remains controversial. PATIENTS AND METHODS In a period of 5 years (2002–2006) eight patients were treated in our department for a penile fracture. The diagnosis was established by a history and clinical examination. In six patients ultrasonography before surgery located the fracture in the right corpus cavernosum, distally from the penoscrotal junction. All patients had immediate surgery using a midline ventral incision and were followed for a mean of 1 year. RESULTS All patients presented with a penile haematoma, while five and two had concomitant scrotal and perineal haematomas, respectively. Penile urethral rupture was associated with corporal cavernosal rupture in one patient. In all patients a 5‐cm midline ventral incision was made at the penile raphe. There was unilateral rupture of the corpus cavernosum in seven patients and bilateral rupture with concomitant urethral rupture in one. The fascial defect was sutured in all patients and an end‐to‐end anastomosis made if there was urethral rupture. The early and late periods after surgery were uneventful. Erectile function was unaffected during the follow‐up. CONCLUSION Immediate intervention for penile fractures, using a midline ventral incision, achieves good early and late results. Our technique has the advantage of direct access to both corpora cavernosa and the anterior urethra, with a minimal skin incision.

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture

“…On long term, 6.6% of patients in our series had ED, which is within the range of 0-16.6% previously reported. [13][14][15][16][17][18][19] We preferred the sub-coronal circumferential incision because of the excellent exposure of the three corpora, which avoids accidental missing of a urethral injury or multiple injuries of the tunica. 26 The right side was commonly affected (56.1%) in agreement with many reports.…”

“…11,13 Contemporary series showed that the incidence of ED after surgical repair of fracture penis ranges from 0% up to 16.6%. 6,7,[13][14][15][16][17][18][19] Several important issues may be raised during discussing the development of ED after surgical repair of fracture penis. First, is delayed presentation after trauma a risk factor for ED?…”

Early Surgical Treatment of Penile Fracture: Our Experience with 19 Patients

“…While the tunica albuginea thickness of penis is about 2 mm in the flaccid state, the thickness decreases about 0.25 to 0.5 mm during penile erection [1]. The most common cause of penile fracture are traumas during sexual intercourse in patient's history [2]. Less often causes are the penis with hands is forced into flexion, the erected penis bended during sleep and falling out of bed [2][3][4][5].…”

“…The most common cause of penile fracture are traumas during sexual intercourse in patient's history [2]. Less often causes are the penis with hands is forced into flexion, the erected penis bended during sleep and falling out of bed [2][3][4][5]. Physical examination is usually sufficient for diagnosis.…”

“…It is based on history and physical examination findings, as accepted by many authors. Moreover, several diagnostic imaging modalities such as urethrography, cavernosography, ultrasonography, magnetic resonance imaging (MRI), and angiography could be used [2,3]. Although early surgical treatment is recommended, some complications such as erectile dysfunction (ED), painful penile erection and loss of penile sensation may be occur in the post-operative period [3,4].…”