The role of ultrasonography in the diagnosis and management of penile trauma

A review of the literature and proposed algorithm for penile fracture management

INTRODUCTION

In the management of penile fractures, immediate surgical repair has resulted in better outcomes when compared with a conservative approach; however, there is currently no consensus on the treatment of patients presenting beyond the immediate period (>24 hours) following injury.

OBJECTIVES

To examine the latest literature on management strategies in penile fracture and propose an optimal algorithm for the treatment of patients with delayed presentation.

METHODS

A comprehensive search was conducted following the PRISMA-P 2020 guidelines. A search was performed in several databases with the following strategy: ("Penile fracture" OR "fracture of penis" OR "rupture of corpora cavernosa" OR "rupture of tunica albuginea") AND (management OR treatment OR surgery OR "surgical reconstruction" OR "surgical repair"). This resulted in 108 relevant articles. Two independent reviewers screened these articles according to the inclusion criteria. Full-text review of 56 articles was performed, and ultimately 20 studies were selected. Measures included the use of diagnostic imaging, timing of surgical repair (immediate, <24 hours after injury; delayed, >24 hours), surgical approach, and long-term complications (ie, erectile dysfunction and penile curvature).

RESULTS

The review highlighted the benefits of immediate surgical repair in penile fractures, demonstrating improved patient outcomes. Furthermore, it found that surgical repair should be considered even in cases with delayed presentation (>24 hours after injury). To better evaluate the long-term impact of delayed surgical intervention on patient outcomes, we recommend standardized postoperative follow-up, with routine assessments of erectile function and penile curvature.

CONCLUSION

Contemporary literature suggests that immediate and delayed surgical repair of penile fractures leads to adequate postoperative outcomes, and patients presenting >24 hours after injury should still be considered for surgery.

Bilateral penile crural fractures due to traumatic injuries: A rare case report and literature review

Penile crural fractures caused by traumatic injuries are rare urological emergencies similar to urethral bulb injuries. This case report discusses the findings of a 59-year-old patient who presented to our emergency department 12 h after an electric bicycle accident. Clinical examination revealed an elevated body temperature, bruised perineal skin, tender penis, and swollen scrotum. Imaging confirmed a penile fracture at the bilateral crus of the penis without considerable urethral trauma. The patient underwent conservative treatment and was followed up on an outpatient basis for approximately three months. Consequently, the patient is relieved of penile pain, has regained erectile function, and reports a satisfactory sexual life. Moreover, this study discusses the efficacy of conservative treatment combined with outpatient follow-up in managing bilateral penile crural fractures.

Penile fracture: A case report

INTRODUCTION AND IMPORTANCE

Penile fracture, resulting from trauma to an erect penis, is a rare urogenital injury with potentially serious complications including erectile dysfunction. This case report emphasizes the significance of prompt recognition, accurate diagnosis, and timely surgical management to optimize patient outcomes.

CASE PRESENTATION

The case involves a 34-year-old male presenting with acute pain, swelling, and a visibly deformed penis following sexual intercourse. Clinical examination confirmed the diagnosis of penile fracture, leading to surgical repair of the tunica albuginea. The patient had an uneventful post-operative recovery and received appropriate post-operative instructions.

CLINICAL DISCUSSION

A penile fracture is a rare but serious injury occurs due to a tear in the tunica albuginea that can occur during vigorous sexual activity causing sudden pain, swelling, and produce a popping sound. Classical presentation often leads to establish a clinical diagnosis. However, immediate surgical exploration and repair is needed for better outcomes and to prevent long term complications such as erectile dysfunction or curvature of the penis that are associated with relying solely on conservative management. Delayed presentation also affects the optimal outcomes of surgery.

CONCLUSION

This report highlights the importance of early surgical intervention, the impact of delayed presentation, and the need for increased awareness regarding penile fractures. This case adds to the existing surgical literature by providing insights into the clinical presentation and management of penile fractures. The comprehensive overview of the case contributes to a better understanding of penile fractures and their management, helping healthcare professionals, improves patient care and outcomes.

Gunshot wounds to the penis and scrotum: a narrative review of management in civilian and military settings

Gunshot wounds (GSW) to the penis and scrotum are present in two thirds of all genitourinary (GU) trauma, with a growing proportion of blast injuries in the military setting. Depending on the energy of the projectile, the injury patterns present differently for military and civilian GSWs. In this review, we sought to provide a detailed overview of GSWs to the external genitalia, from mechanisms to management. We examine how ballistic injury impacts tissues, as well as the types of injuries that occur, and how to assess these injuries to the external genitalia. If there is concern for injury to the deep structures of the penis or scrotum, operative exploration and repair is warranted. Relevant history and physical examination, role of imaging, and choice of conservative or surgical treatment options in the civilian and military setting are discussed, as well as guidelines for management set forth by the American Urological Association (AUA) and European Association of Urology (EAU).

Penile Dorsal Vein Rupture Identified by Emergency Department Ultrasound

Case Presentation

We present the case of a young male with high clinical suspicion of a penile fracture found to have dorsal vein rupture by emergency department point-of-care ultrasound. This false form of penile fracture was subsequently confirmed intraoperatively.

Discussion

Penile fracture is a rare clinical entity that may be separated into true vs false penile fracture, with only true fracture requiring surgery. The images submitted here add to the sparse literature evidence that point-of-care ultrasound can be used to differentiate between these two clinical entities. Additionally, this case report highlights an opportunity for further research into and application of point-of-care ultrasound to the evaluation of suspected penile fractures.

Acute penile trauma: imaging features in the emergency setting

In an emergency department, penile traumas are uncommon and a prompt diagnosis is necessary. Penile injury may result from penetrating and non-penetrating trauma. Non-penetrating injuries can produce cavernosal hematomas or fractures: if not treated promptly, these lesions can result in fibrosis or erectile dysfunction. Penile traumatic lesions need a clinical approach first, but a radiological study is often required: ultrasonography with color and spectral Doppler study is usually the first approach. In some cases, magnetic resonance imaging may be performed to better recognize even small discontinuity of the tunica albuginea. Radiologists have to be aware of the various radiological patterns of penile traumatic lesions, in order to establish a prompt and correct diagnosis.