Penile Fracture

Question 1

Pathophysiology

Answer 1

A rare urological emergency that warrants prompt surgical intervention.

Traumatic rupture of corpus cavernosa and tunica albuginea in an erect penis.

The tunica albuginea is around 2mm in flaccid, but 0.5mm in erect.

Pressure of up to 1500mmHG in corpus cavernosa from bending through blunt trauma can result in rupture.

Question 2

Causes

Answer 2

Blunt trauma as penis is violently deviated away from its axis.

Penetrative intercours with partner on top

Forceful masturbation

Falling from bed with erect penis

Forceful correction of congenital chorde

Question 3

Clinical features

Answer 3

History of trauma

Popping sensation or hearing a snap

Immediate pain, swelling and detumescence

Penile swelling and discolouration called aubergine sign.

Potential deviation away from the lesion

A firm immobile haematoma in the perineum can suggest urethral injury.

Question 4

Investigations

Answer 4

Diagnosed clinically

Should have routine pre-op bloods

Cavernosography can be used in cases of suspected penile fracture or in delayed presentation

If tehre is concurrent urethral injury retrograde urethography should be performed.

Question 5

Management

Answer 5

Analgesia and anti-emetics before urgent surgical exploration and repair

Circumferential incision arnd the penis skin is de-gloved proximally.

The haematoma should be evacuated before the tear is identified and repair with absorbable sutures.

Question 6

Further management

Answer 6

Abstinence from all sexual activities for 6-8 weeks should be done

Question 7

Complications

Answer 7

Curved penis

Penile paraesthesia

Dyspareunia/painful erection