Penile fracture

Question 1

What is a penile fracture?

Answer 1

• Urological emergency
• Traumatic rupture of corpus cavernosa and tunica albuginea in an erect penis

Question 2

Cause of penile fracture

Answer 2

• Blunt trauma
• Penis violently deviated away from its axis

Common mechanisms of injury inc:
* Penetrative intercourse with partner on top
* Forceful masturbation
* Falling from bed with erect penis
* Forceful correction of congenital chordee (curved penis, urethra often on underside)

Question 3

Tunica albuginea during erections

Answer 3

• 2mm when penis flaccid
• Thins to 0.5mm during erection
• Pressures of up to 1500mmHg in corpus cavernosa through blunt traum = rupture

Question 4

Symptoms of penile fracture

Answer 4

• Slipping of penis from vagina with forceful thrusting to the pubic symphysis or perineum
• Then popping sensation or audible snap, with immediate pain, swelling and flaccidity

Question 5

Examination of penile #

Answer 5

• Penile swelling
• Discolouration - secondary to haematoma - ‘Aubergine sign’
• Potentially deviated towards opposite side of lesion
• Firm, immboile haematoma may be palpated in shaft - ‘Rolling sign’
• Butterfly shaped haematoma in perineum may suggest urethral injury

Question 6

Differentials for penile # presentation

Answer 6

• Rupture of dorsal artery or veins
• Rupture of suspensory ligaments
• But both of these have lack of popping sensation

Question 7

Investigations for penile #

Answer 7

• Diagnosed clinically
• Routine pre-op bloods eg FBC, U&E, LFT, clotting, G&S, CRP

Question 8

What can be used in cases of penile fractures that are unsure or delayed presentation?

Answer 8

• Cavernosonography
• Identify rupture site - BUT risk of false negative when rupture site sealed with clot
• Also used intra-operatively for this
• BUT has been associated with complications of priapism and fibrosis of corpus cavernosum

Question 9

Investigation if patient has suspected urethral injury eg voiding difficulty or blood on meatus

Answer 9

• Retrograde urethrography - contrast into urethra with x-rays

Question 10

Management of penile #

Answer 10

• Analgesia
• Antiemetics
• Urgent surgical exploration and repair

Question 11

Surgical procedure for penile #

Answer 11

• Penile skin de-gloved up to base from proximal
• Haematoma evacuated
• Tear is identified and repaired using absorbable sutures

Question 12

Sexual acitivty post #?

Answer 12

• Abstinence from all sexual activity for 6-8 weeks is recommended post surgery

Question 13

Delayed presentation of penile #

Answer 13

• If present within 1 week of injury - vast majority can have surgical fix
• If beyound this, monitor as outpatient specifically for signs of ED, and Peyronies disease

Question 14

Peyronies disease

Answer 14

Scar tissue (plaque) in your penis, within tunica albuginea, causes it to bend, curve or lose length or girth

Question 15

Complications of penile #

Answer 15

• Penile curvature during erection
• Penile parasthesia
• Dysparaunia/painful erection

Only in 5% of cases usually, prognosis with surgery is good