Penile fracture: experience in 56 cases

Effect of cyanoacrylic glue on penile fracture: an experimental study

PURPOSE

We investigated the effect of Glubran(R)2 cyanoacrylic glue on rat cavernous tissue after forming penile fractures experimentally as well as the histopathological effect. We also investigated its clinical use.

MATERIALS AND METHODS

Experimental penile fracture was formed by incising from the proximal dorsal side of the penis in 32 Wistar Albino rats. The rats were randomly assigned to 4 main groups of 8 each. In the control group the incision was not repaired and it was left to secondary healing. In the glue group cyanoacrylic glue was only applied to the incision region. In the primary repair group the incision was primarily repaired and in the final group cyanoacrylic glue was applied to the incision region following primary repair. Three weeks later penectomy materials were examined histopathologically.

RESULTS

When the control group was compared with the other groups, the differences in cavernous tissue healing with fibrosis and hyperemia-bleeding were statistically significant (p = 0.043 and 0.003, respectively). In the glue group fibrosis was observed in 2 rats. This group was the best according to cavernous healing. Although there was no significant difference between the control group and the other groups according to inflammation (p = 0.057), the glue group was better than the primary repair group (p = 0.026). No significant inflammation or hyperemia-bleeding was observed in the glue group. When the experimental groups were evaluated for histopathological parameters, it was observed that the best results were obtained in the glue group.

CONCLUSIONS

Cyanoacrylic glue can be used in cavernous surgery due to its hemostatic, adhesive and anti-inflammatory properties.

Penile fracture: surgical repair and late effects on erectile function

INTRODUCTION

Penile fracture is described as a traumatic rupture of the tunica albuginea because of blunt injury of an erect penis.

AIM

To assess the etiology, treatment maneuvers, and late effects of penile fractures treated by surgical repair.

METHODS

Thirty-three patients diagnosed provisionally as having fractured penises. Thirty patients were managed by immediate surgical repair and three by delayed repair.

MAIN OUTCOME MEASURES

International Index of Erectile Function-5 for married cases and Single-question Self-report of Erectile Dysfunction questionnaires and recording complications after 2, 3, and 6 months.

RESULTS

The most common cause of fracture penis is self-inflicted acute bending (54.5%). The tear was visualized by ultrasound in 20/30 patients (66.7%) mostly on the right proximal third of the penis. All tears were unilateral with mean length 2.0 +/- 0.9 cm (range 0.5-4 cm). All patients who completed their follow-up after 6 months (N = 24) were able to achieve an adequate erection except two married cases who felt mild erectile dysfunction. Penile nodules were the most common postoperative complication (41.7%) after 6 months' follow-up. Patients treated with immediate or delayed repair had comparable complications.

CONCLUSIONS

Fracture penis is not uncommon as an emergency that must be repaired either immediately or delayed. Clinical diagnosis is more predictive than ultrasound in diagnosis and determining the site of the tear. Ultrasound may be of value in patients where there is clinical doubt.

Fracture of the penis: management and long-term results of surgical treatment. Experience in 300 cases

BACKGROUND

Herein, we present the largest series of penile fracture ever published. We evaluate the clinical presentation, the outcome of the treatment and the prognosis.

METHODS

We retrospectively studied patients with penile fracture treated from 1975 to 2005.

RESULTS

Three hundred patients were included in this study. The mean patient age was 30 years (range, 18-68 years). Out of these patients, 57 (19%) patients were injured during sexual intercourse, whereas 180 (60%) patients were injured during masturbation. The mean time from injury to presentation was 26 hours. The diagnosis was clinical in all cases. No further investigation was needed for confirming the diagnosis. Five patients had urethral bleeding with urethral lesion. All patients were treated by immediate surgery. All of the patients had a tunica albuginea tear that was promptly repaired. At follow-up (mean time of 7 years), 14 patients presented mild curvature, which had not hindered intercourse in 10 patients. The Nesbit intervention was performed in four patients. Penile pain at intercourse developed in four patients (1.3%) and at erection in six patients (2%). Erectile dysfunction was observed in two cases (0.6%).

CONCLUSION

Penile fracture has typical clinical signs. Early surgical treatment is associated with a low incidence of late complications. The high frequency in our area is neither because of physical nor genetic particularities. It is probably because of sociocultural characteristics.

Dorsal Vein Injuries Observed During Penile Exploration for Suspected Penile Fracture

INTRODUCTION

Penile fracture is a rare injury, bearing potential impairment of erectile function if not treated. Patients with clinical presentation of a penile fracture commonly undergo early surgical exploration with the intention to repair a tunica albuginea tear.

AIM

We present a group of men who presented with a penile hematoma following trauma to the erect penis. Exploration revealed an intact tunica albuginea and a dorsal vein tear.

METHODS

Eighteen men (mean age 38 years, range 20-55) presented with suspected penile fracture during an 8-year period. One man presented twice. Two of the patients were managed expectantly and the remaining 16 patients underwent 17 immediate surgical explorations. Explorations were performed under general anesthesia, using a circumferential subcoronal incision and degloving of the penile skin. The tunica albuginea of both penile sides as well as the penile urethra were examined for injuries.

MAIN OUTCOME MEASURES

Medical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function, medical treatment for erectile dysfunction, and penile curvature were obtained during follow-up.

RESULTS

In nine of the 17 procedures the tunica albuginea was intact and the only pathological finding was a ruptured dorsal vein. One procedure was negative for both tunical and vascular injury. A tunical tear was detected in the remaining seven procedures. At a mean follow-up of 40 months (range 4-91), five patients required medical treatment for erectile dysfunction, including the two who were managed expectantly, two with a tunical tear, and one with a venous tear.

CONCLUSIONS

Dorsal vein tears may mimic penile fracture. Suggestive findings following trauma to the erect penis prompted exploration for suspected tunica albuginea tear. In less than half of the men was the diagnosis of penile fracture established and treated at surgery.

False penile fracture: report of 16 cases

We determined the value of diagnostic and therapeutic approaches of false penile fractures and the outcome of treatment. We retrospectively reviewed 16 cases of presumed penile fracture with a negative surgical exploration. Clinical presentation, technique of treatment and outcome were noted. The mean age was 39 years (17-64). Nine patients were injured during sexual intercourse. All the patients presented with the presumptive diagnosis of penile fracture. False penile fracture was evoked in one patient presenting a new erection. Surgical penile exploration was carried out for all the patients without any radiological explorations. It revealed nonspecific dartos bleeding in 10 cases and avulsed superficial dorsal vein in six cases requiring venous ends ligation. All the patients regained penile appearance and potency. We can hardly distinguish false penile fracture from 'true' penile fracture with certainty either clinically or radiologically, thus, surgical exploration is mostly necessary. The prognosis is excellent.

Approach to management of penile fracture in men with underlying Peyronie’s disease

OBJECTIVES

To report on a series of patients with Peyronie's disease (PD) who experienced a penile fracture, examining the history, presentation, and management. Additionally, we describe an unreported surgical technique implementing combined fracture repair and tunica plication. PD is an acquired inflammatory condition of the penis that can cause fibrotic, nonexpansile thickening of the tunica albuginea, resulting in a focal bend or narrowing on erection.

METHODS

From October 1999 to July 2003, 4 patients with nonsurgically treated PD had a penile fracture during sexual activity. The mean patient age was 43 years (range 29 to 52), with an average of 5.5 days (range 3 to 8) transpiring from the time of penile trauma to surgery in the men presenting early. Penile ultrasonography was used to locate the site of tunica laceration.

RESULTS

Either circumcising or ventral midline incisions were selected to treat these patients. During penile exploration, the tunica defect in the corpus cavernosum was identified and closed with 2-0 Maxon suture. Subsequent artificial erection displayed penile curvature in 3 patients, and plication was then performed to straighten the tunica angulation using 2-0 TiCron suture. The fourth patient had a minimal bend with slight waisting, not requiring plication. No perioperative complications occurred. These 4 patients regained their preoperative level of erectile rigidity with lasting nonpainful correction of their deformity.

CONCLUSIONS

Patients with PD who have a penile fracture are candidates for combined fracture repair and tunica plication at the same setting.

Penile lesion from gunshot wound: a 43-case experience

OBJECTIVE

To demonstrate the main aspects of diagnosis, treatment and follow-up of 43 patients with gunshot wounds to the penis.

MATERIALS AND METHODS

The location of the lesion, the presence of associated lesions, the performance of complementary exams, surgical treatment, postoperative complications and long term follow-up of 43 patients with penile lesions from gunshot wounds were retrospectively analyzed.

RESULTS

Of 43 cases assessed, 41 were submitted to surgical exploration (95.3%) and 2 were submitted to conservative treatment (4.7%). We found penile lesions involving the corpus cavernosum in 37 cases; the remaining 4 patients presented no lesions involving the corpus cavernosum, urethra or testicles but did in the superficial structures. Ten cases presented an association with testicular lesions and 14 cases association with anterior urethral lesions.

CONCLUSION

Penile lesions from gunshot wounds should be treated with immediate surgical intervention. In exceptional situations featuring superficial lesions only conservative treatment may be applied.

Penile fracture

BACKGROUND

A 23-year-old man presented with a painful penis following sexual intercourse. On examination he had a swollen, bruised penis that was tender on palpation, most markedly on the right lateral aspect.

INVESTIGATIONS

Urinalysis.

DIAGNOSIS

Rupture of right corpus cavernosum.

MANAGEMENT

Immediate surgical repair.

Fractured penis

PURPOSE

To provide nurse practitioners (NP) with information concerning the uncommon occurrence of penile fracture, a review of the anatomy and physiology of the penile shaft, signs and symptoms to be included in assessment, diagnostic tests, treatment, and referral are discussed.

DATA SOURCES

Current literature available in journals and textbook, and clinical experience.

CONCLUSIONS

Penile fracture, although an uncommon incident, is an urgent condition that requires a urology consult and surgical repair.

IMPLICATIONS FOR PRACTICE

Because of the serious nature of this injury and the potential for complications, NPs need to obtain an urgent urology consult when penile fracture is suspected or diagnosed. The characteristic typical clinical presentation usually eliminates the need for expensive or invasive tests for diagnosis.

Fratura de pênis

OBJETIVO: Analisar as circunstâncias, o diagnóstico, o tratamento e a evolução dos pacientes com fratura de pênis. MÉTODO: Foram acompanhados 19 pacientes no período de 1999 à 2003 com diagnóstico de fratura de pênis. RESULTADOS: Quinze pacientes submetidos ao procedimento cirúrgico nas primeiras 48 horas evoluiram bem. Os demais quatro pacientes que foram submetidos ao tratamento clínico, por diversos fatores, evoluiram com deformidade peniana. CONCLUSÕES: Afecção que ocorre somente quando o pênis encontra-se em ereção, o tratamento cirúrgico precoce é o que demonstra melhores resultados, com preservação da função erétil.