Fracture of the penis and long-term results of surgical treatment

Penile fracture: Institutional experience of 14 cases

Background:

Penile fracture due to various causes is urological emergency condition, which can be diagnosed on history and clinical examination of the patient. Appropriate management in each case prevents patients from future physical and psychological consequences.

Materials and Methods:

Fourteen patients were included in the study. The study was carried out at Ruby Hall Clinic, Pune, India, between January 1, 2016, and December 31, 2019. All patients were evaluated by history and clinical examination and radiographic investigation in suspected urethral injury.

Results:

Fourteen patients with penile fracture, between 20 and 50 years, were in the study. The most common mechanism of injury was abnormal positional coital activity. About 85.71% of patients were diagnosed with a history and clinical examination. Ninety-three percent of patients were treated surgically and had a successful outcome. One patient had associated urethral injury. All patients had good sexual function posttreatment except one who later recovered well on medical management.

Conclusion:

Early diagnosis and treatment of patients with penile fracture depend on the history and clinical examination with less role of radiological investigations. The appropriate treatment gives a good outcome.

Complete urethral injury in the penile fracture: a case report and literature review

Penile fracture is described as a traumatic rupture of the tunica albuginea caused by blunt injury to the erect penis. It usually occurs as a single rupture of the tunica albuginea in one of two corpora cavernosa; a rupture with urethral injury is an extremely rare condition. Although its diagnosis is usually clinical, ultrasound plays an important role in confirming diagnosis and identifying the site of the injury. Here, we presented a case of penile fracture with complete urethral injury. A 43-year-old male was admitted to the hospital because of trauma to the genital and dysuria following sexual intercourse. After admission, the patient was diagnosed with double penile fracture and complete urethral injury after the physical and B-ultrasound examinations. Emergency surgery to remove the hematoma and repair the urethra was performed. The patient recovered smoothly and was discharged on the third day after operation. After two months’ follow-up, the patient urinated smoothly and achieved an adequate erection without other complications. In this case, consistent with previous studies, emergency surgery for penile fracture is necessary and can preserve the urethral function and sexual function. In addition, there are two lesions in tunica albuginea in this case, so careful search for the penile shaft during the surgery is important to avoid the missed injuries. This report provides evidence of an uncommon and underreported clinical case.

Rupture of the Corpus Cavernosum in a Pediatric Patient

ABSTRACT

Pediatric penile pain is an uncommon complaint and is associated with a wide differential diagnosis including infectious, inflammatory, traumatic, and idiopathic conditions. Penile fractures, anatomically known as rupture of the corpus cavernosum, are almost exclusively reported in sexually mature patients and usually involve forceful manipulation during sexual activity. Rupture of the corpus cavernosum is a true urologic emergency. Failure to recognize and treat rupture of the corpus cavernosum has been associated with residual penile angulation, persistent hematoma, abscess, erectile dysfunction, and fibrosis. We present the case of a previously healthy 7-year-old boy who presented to our emergency department with complaints of penile pain with movement after falling and colliding with staircase railing. Examination showed ecchymosis and swelling of the penile shaft; both testicles were palpable and nontender, with no perineal or scrotal bruising. Ultrasound noted discontinuity along the right corpus cavernosum consistent with a rupture of the right corpus cavernosum. Testicles were noted to be in the scrotum with normal Doppler flow. Flexible cystoscopy revealed an uninjured urethra and bladder. Our patient was urgently taken to the operating room for repair of his injury. Thanks to the timely surgical correction, there were no postsurgical complications, and he was discharged home on postoperative day 1. This case demonstrates that although most reports of corpus cavernosum injuries are associated with sexual intercourse, other modes are possible and should be considered for acute-onset penile pain in pediatric patients.

Sexual function outcomes and risk factors of erectile dysfunction after surgical repair of penile fracture

OBJECTIVE

To determine the erectile dysfunction (ED), overall sexual function, and risk factors for developing ED after surgical repair of penile fracture.

MATERIAL AND METHODS

This was an ambispective observational study conducted from September 2014 to August 2019, which included 68 patients with a clinical diagnosis of penile fracture. The clinical presentation, etiology, and surgical details were recorded. Patients were contacted via telephone and called for follow-up. Their sexual function was objectively recorded using the sexual health inventory for men questionnaire, erection hardness grading scale, and the brief male sexual function inventory (BMSFI). Patients were categorized in 2 groups on the basis of ED. These 2 groups were compared on the basis of preoperative and intraoperative factors to determine the predictors of postoperative ED.

RESULTS

The mean age at presentation was 33.64±9.46 (range, 19-54) years. The most common mode of injury was injury during the sexual intercourse (78%). All the patients underwent surgical exploration through subcoronal degloving incision. On follow-up, 7 patients (11.3%) developed ED (mild ED, 5 patients; mild-to-moderate ED, 2 patients). Per BMSFI, 58 (93.5%) patients had no bothersome issues with their sexual life, and they were mostly satisfied. The significant risk factors for ED were age >50 years and bilateral corporal involvement.

CONCLUSION

Penile fracture is a true urological emergency, and prompt diagnosis by clinical acumen and emergent surgical exploration provide good functional results with low morbidity. The main predictors of postsurgical ED are increasing age (>50 years) and bilateral corporal involvement.

Clinical spectrum, diagnosis, and sexual dysfunction after repair of fracture penis: Is no news good news?

Introduction

Penile fracture is a rare urological emergency, best managed by early surgical intervention, but the data on subsequent sexual function is sparse. This study was designed to analyze the clinical spectrum and sexual function after penile fracture repair at our tertiary care center.

Materials and Methods

Ambispective observational study was undertaken from July 2002 to August 2019 which included patients admitted with a history of trauma to the penis in the erect state. The clinical presentation, etiology and the details of the surgical management were noted. Patients were contacted telephonically and were called for follow-up. They were evaluated for the presence of penile nodules or curvature, and the erectile function was objectively recorded using the Sexual Health Inventory for Men (SHIM) questionnaire and the Erection Hardness Score (EHS).

Results

Median age at injury was 37 years, and injury during the sexual intercourse (33/43) was the most common etiology. Five patients presented with blood at the meatus. Ultrasound was performed in 27 patients and could detect the injury with a 55% sensitivity. All but one case were repaired through a subcoronal degloving incision. At a median follow-up of 36 months, follow-up data of 20 patients were available. Of the 20 patients, 14 were sexually active. The mean SHIM score was 21.36 ± 1.33 and the mean EHS was 3.21 ± 0.43. Four of the 20 patients developed penile nodule while 2 of them had penile curvature which was not bothersome.

Conclusion

Penile fracture remains primarily a clinical diagnosis. Although prompt diagnosis and an emergent surgical exploration provides good outcomes in terms of preservation of erectile function, patients should be apprised about the problems of penile nodule and curvature.

Current Management of Penile Fracture: An Up-to-Date Systematic Review

INTRODUCTION

Because of the low incidence of penile fracture, many aspects of the diagnostic process and of the surgical and functional outcomes are rarely reported.

AIM

To systematically review the current literature on the surgical management of penile fracture, focusing on etiology, diagnosis, functional outcomes, and postoperative complications.

METHODS

The present review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration standards for systematic reviews. A systematic search for the terms penile fracture, fracture of penis, trauma of penis, rupture of corpora cavernosa, and immediate management of penile fracture was been carried out in the PubMed, EMBASE, Cochrane, SCOPUS, and Science Citation Index databases.

MAIN OUTCOME MEASURES

Etiology of penile fracture, clinical presentation, types of radiologic investigations and their accuracy, surgical approach, suture material used for tunica repair, timing of surgical exploration, intraoperative findings, surgical complications, and functional outcomes.

RESULTS

The total number of patients analyzed was 438, and the patients' an average age was 36 years. The most frequent reported cause of penile fracture was sexual intercourse (80% of cases). The most common finding at examination was a penile hematoma (97.5%). Although operator dependent, in experienced hands, ultrasonography was found to be a useful tool in confirming the location of the albuginea tear and identifying the presence of any concomitant urethral injury, helping the surgeon to choose the best surgical approach. Early surgical repair of a penile fracture was found to be a safe procedure, although long-term complications are not uncommon. Tertiary referral centers that managed a larger number of cases seemed to obtain more satisfactory long-term results with a significantly smaller number of complications.

CONCLUSION

A low incidence of postoperative complications and full satisfactory functional outcomes are reported when early repair is performed in high-volume centers. Falcone M, Garaffa G, Castiglione F, Ralph DJ. Current Management of Penile Fracture: An Up-to-Date Systematic Review. Sex Med Rev 2018;6:253-260.

Penile Fracture: A Meta-Analysis

OBJECTIVES

To review the causes and management of penile fracture and to compare between surgical and conservative management as well as immediate and delayed interventions in terms of overall and specific complications.

METHODS

A search of all reported literature was conducted for all articles reporting on the management and outcomes of penile fractures. Full texts of relevant articles were obtained and screened according to the inclusion criteria. Outcomes measures were numbers of patients receiving surgical or conservative management, aetiology of fracture, length of admission, complications as well as the specifics of diagnostic approaches and operative management. Data was collated and where possible meta-analysed using Revman software.

RESULTS

A total of 58 relevant studies involving 3,213 patients demonstrated that intercourse accounts for only 48% of cases with masturbation and forced flexion accounting for 39%. Meta-analysis shows that surgical intervention was associated with significantly fewer complications vs. conservative management (p < 0.000001). Surgical intervention results in significantly less erectile dysfunction (ED), curvature and painful erection than conservative management. There was no significant difference in the number of patients developing plaques/nodules (p = 0.94). Meta-analysis shows that overall early surgery is preferable to delayed surgery but that rates of ED are not significantly different.

DISCUSSION

Early surgical intervention is associated with significantly fewer complications than conservative management or delayed surgery. The combined outcome of rapid diagnosis by history and clinical examination and swift surgical intervention is key for reconstruction with minimal long-term complications.

Isolated penile urethral injury: A rare case following male coital trauma

Penile fractures are an uncommon urological emergency. Typically, penile fractures involve the corpus cavernosum and are sometimes associated with urethral injury. Isolated corpus spongiosum and urethral injuries without concomitant corpus cavernosum injury are, however, rare. With proper knowledge of the management of penile fractures and urethral injuries, this distinct entity can be diagnosed, assessed and managed successfully without complications.

Sexual function outcomes following fracture of the penis

INTRODUCTION

Fracture of the penis is a rare urological emergency which occurs as a result of abrupt trauma to an erect penis. There is paucity of data regarding long-term sexual function or erectile potency following fracture of the penis. The aim of this study is to objectively assess the overall sexual function following fracture of the penis.

METHODS

A retrospective analysis of 21 penile fractures was performed. A voluntary telephone questionnaire was performed to assess long term outcomes using three validated questionnaires-the Erection Hardness Grading Scale, the International Index of Erectile Function (IIEF-5) and the Brief Male Sexual Function inventory (BMSFI).

RESULTS

The mean age was 33.1 years (range: 19-63). The median follow up was 46 months (range: 3-144). All fractures were a result of sexual misadventure and all were surgically repaired. There were two concomitant urethral injuries. Seventeen patients were contactable. Fourteen patients demonstrated no evidence of erectile dysfunction (ED) (IIEF-5>22), 1 patient reported symptoms of mild ED (IIEF-5, 17-21) and one patient reported mild to moderate ED (IIEF-5, 12-16). No patients reported insufficient erection for penetration (EHGS: 1 or 2). Regarding the overall BMSFI, 13 (83%) patients were mostly satisfied or very satisfied with their sex life within the previous month.

CONCLUSION

In a small surgical series of men with penile fracture managed within a short time frame from presentation, we demonstrate erectile potency is maintained. Long-term overall sexual satisfaction is promising.

Penile fracture: experience from a third world country

Aim. To ascertain the clinical presentation, commonest age group affected, and treatment of patients diagnosed to have penis fracture. Materials and Methods. We performed a retrospective study carried at a tertiary care hospital from January 2005 to January 2011. All the 36 patients diagnosed to have penile fracture were enrolled in the study group. The diagnosis was made based on the clinical findings in the patients. All, except two patients, were managed by a standard surgical procedure, same for all the patients, on the day of presentation to the hospital. All the data pertaining to the presentation, management, and followup of these patients were studied and scrutinized thoroughly. Results. Thirty-four patients were operated while 2 refused surgery. Most of our patients were between 16 and 30 years (55.6%) of age. The commonest presenting complaints were penile swelling and detumescence during sexual intercourse or an erection. All except two of our patients were managed with immediate surgical repair which had excellent results even in the presence of associated urethral injury. Conclusion. Fracture of the penis is a surgical emergency which can be best managed by immediate surgical repair with excellent results even in the presence of urethral injury.

Penile fracture with bilateral corporeal rupture and complete urethral disruption: case report and literature review

Penile fracture is a rare injury most commonly sustained during sexual intercourse. We report the case of a 35-year-old man who presented with bilateral rupture of the corpora cavernosa and complete disruption of the urethra. A review of the literature on penile fracture is also presented. Urgent surgical exploration was performed and the injuries repaired primarily. In follow-up, the patient reported satisfactory erectile function. This case highlights the importance of early surgical repair and evaluation for concomitant urethral injuries in cases of penile fracture.

Relationship between penile fracture and Peyronie's disease: a prospective study

Peyronie's disease is postulated to be initiated by repetitive minor traumas to the fully or partially erect penis. We investigated Peyronie's disease prospectively in cases treated for penile fracture (PF) within the last 20 years. Medical records of 63 cases treated for PFs were reviewed. Subjects were required to self-assess their current penile morphologies and sexual functions. Penile nodules and Peyronie's plaques were also evaluated with physical examination, ultrasonography and magnetic resonance imaging (MRI), and penile curvatures with auto-photography, and sexual function with international erectile function index (IIEF). Of the 63 cases (mean age 37 years), 46 who had mean follow-up of 63 months were re-evaluated. The mean IIEF-5 score was 23.2±3.1. Painful erections (n=5), penile nodules (n=5) and also penile curvatures <20° (n=2) were investigated. No Peyronie's plaque was palpated in any of the cases. Ultrasound and MRI showed fibrotic nodules of 5 mm in diameter, which extended into the subtunical area in the rupture site in 54% of the cases, although any thickening and Peyronie's plaque were not found in the tunica albuginea and intracavernosal septum of the cases examined. In PF patients treated surgically, the erectile function and penile morphology were preserved. In our cases PFs did not induce the development of Peyronie's disease.

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.

Management of urethral lesions in penile blunt trauma

BACKGROUND

Traumatic lesions to the penis may extend into the corpus spongiosum, causing laceration or complete transection of the urethra. Blunt penile trauma is usually related to sexual intercourse or manipulation. The aim of this paper was to report the authors experience with the management of urethral injuries in patients with penile blunt trauma.

METHODS

The charts from 77 patients with penile blunt trauma were retrospectively reviewed, and the cases associated with urethral injuries associated were selected. Patient age ranged from 18 to 63 years (mean 33 years).

RESULTS

From 77 cases assessed, 11 (14.2%) patients had urethral injury, 62 (80.5%) had injury of the corpora cavernosa and four (5.2%) had injury of the dorsal vein. The etiology of urethral injuries was sexual intercourse in 10 patients (91%) and direct trauma to the flaccid penis in one patient (9%). A partial urethral disruption was presented in eight patients (72.8%) and a total disruption in three patients (27.2%). Preoperative urethrogram was performed in seven patients with a suspicion of urethral trauma. When a partial injury was present the urethra was closed over the catheter, and in the presence of a total injury an end-to-end anastomosis was performed.

CONCLUSION

The data support the reported incidence of urethral injury associated with blunt penile trauma. No clinically apparent urethral structures were appreciated with primary urethral repair after a follow up of more than 6 months.

Fractured penis: a clinical misnomer!

BACKGROUND

A 'fracture' of the penis refers to a tear in the deep layer of the tunica albuginea (Buck's fascia) and may be associated with a urethral injury.

AIM

To describe a classical case of a 'fractured' penis and discuss the management options.

METHOD

A case report of a 30-year-old man presented with a 'fractured' penis and who underwent surgical intervention.

CONCLUSION

This rare occurrence represents a urological emergency and necessitates imaging and repair of the cavernosal defect in order to prevent poor functional outcome.

Bilateral disruption of corpus cavernosum with complete urethral rupture

Penile fracture is a relatively rare condition. We report an unusual case of the bilateral disruption of the corpus cavernosum with complete urethral rupture resulting from blunt trauma during sexual intercourse. The subject underwent emergency surgery with preservation of erectile and voiding functions in the follow-up.

Penile fracture: experience in 56 cases

OBJECTIVE

The aim of this work is to report the diagnostic and therapeutic options for 55 patients with clinical diagnosis of penile fracture.

MATERIAL AND METHODS

The patients were retrospectively assessed between 1982 and 2002. The primary diagnostic evaluation method for 55 patients (56 fractures) was clinical history and physical exam. Ten (17.8%) cases required complementary exams. Ultrasound (US) was performed in 2 cases, and magnetic resonance imaging (MRI) in 1 case. Retrograde urethrocystogram was performed in suspicious urethral injury, which happened for 7 patients.

RESULTS

Of 56 assessed cases, 49 (89.5%) were submitted to surgical exploration, and only 7 were conservatively conducted. Surgical treatment was performed in 48 patients (49 fractures), in these cases, 47 (95.9%) presented tunica albuginea disruption and solely 2 (4.1%) evidenced lesion of dorsal vein. Ultrasonography confirmed disruption of tunica albuginea in 1 (50%) case, and in the other it was not possible to determinate the origin of the lesion, and the patient was submitted to surgical exploration, which confirmed the condition. MRI was used only in 1 case, confirming the lesion. Among 7 patients submitted to conservative management, until now, 3 (42.8%) required surgical intervention to correct penile chordee.

CONCLUSIONS

Penile fracture is an entity of eminently clinical diagnosis, which management should be surgical and immediate, avoiding thus complications related to erectile dysfunction. When suspecting an associated urethral injury, Urethrocystogram is recommended. In cases where there is diagnostic uncertainty, ultrasound and/or MRI may be used to reveal the condition.

Evaluation and treatment of penile fractures: accuracy of clinical diagnosis and the value of corpus cavernosography

OBJECTIVES

To assess the accuracy of clinical diagnosis and feasibility of treatment on the basis of cavernosographic findings in men with clinical features consistent with penile fracture.

METHODS

Forty consecutive patients (mean age 32 years, range 18 to 65) who presented with a history of blunt penile trauma and clinical signs and symptoms indicating penile fracture during the past 11 years were included. The charts of the first 13 patients, who were seen between 1990 and 1994 and were treated surgically on the basis of the clinical findings, were reviewed retrospectively. In the next 27 patients, a prospective study was designed and treatment was determined according to their cavernosogram findings: 21 with evidence of corporal injury treated surgically and 6 with normal imaging treated conservatively. The follow-up ranged from 3 to 32 months (mean 14).

RESULTS

The clinical diagnosis of penile fracture was accurate in 11 of 13 patients and was false in 2 (15%). In the prospective study, corporal injury as determined by cavernosography was confirmed surgically in all cases. The cosmetic and functional results were satisfactory in all, including the patients treated conservatively. No serious complication was reported.

CONCLUSIONS

In men with blunt penile trauma, the clinical presentation can be misleading and may result in unnecessary surgery. The results also demonstrated that cavernosography is a useful investigation method and may be helpful in selecting the treatment approach in these cases.

Fracture of the penis

BACKGROUND

Sporadic reports of penile fracture give the impression of a rare trauma. The value of diagnostic investigations is doubtful and treatment options are controversial.

METHODS

A Medline search from January 1966 to July 2001 using the terms 'fracture of penis', 'penile trauma' and 'coital injuries' was used to identify full texts of publications on fracture of the penis. Full texts of relevant references from these publications were also identified. Data extracted for review included authors, country and year of publication, number of cases in each report, aetiology, clinical features, investigations, treatment and outcome.

RESULTS

In 183 publications 1331 cases were reported between January 1935 and July 2001. Most reports were from the Mediterranean region. The commonest causes were coitus and penile manipulations, especially masturbation. Most patients were in their fourth decade. Clinical features included sudden penile pain, detumescence, voiding difficulties, and penile swelling and deviation. Diagnosis was made mainly on clinical grounds. Associated injuries included urethral rupture. Predisposing factors included excessive force at coitus or manipulation, fibrosclerosis of the tunica albuginea and chronic urethritis. Most authors advocated early surgical repair using absorbable sutures. Complications of the injury included coital difficulty, urethral fistula, penile plaque and erectile dysfunction.

CONCLUSION

Penile fracture is not rare. Radiological investigations are expensive and may delay treatment. Current management favours early surgical exploration to prevent complications.

Nonoperative treatment of patients with presumed penile fracture

PURPOSE

Immediate surgical intervention is the basis for treatment of penile fractures due to the high risk of complications associated with conservative management. Unfortunately, patient refusal to undergo surgery has led to conservative treatment of a small group of patients with presumed penile fractures at our institution. We followed these patients in regard to clinical outcome.

MATERIALS AND METHODS

Between 1992 and 1999, 5 patients were evaluated after blunt trauma to an erect penis. Patient age at presentation ranged from 19 to 31 years (mean 25). The interval from time of injury to presentation was 24 to 72 hours. Of these patients 4 had been injured during sexual intercourse, while 1 had been injured during masturbation. All 5 patients refused immediate surgical exploration for presumed penile fracture.

RESULTS

No patient had any immediate complications. At 6 and 12-month followup all patients reported erections adequate for intercourse without associated pain. One patient reported only mild curvature for which he did not seek treatment.

CONCLUSIONS

We report on a subset of young males with presumed penile fracture who refused diagnostic evaluation and therapy, and were able to maintain normal erectile and voiding function. However, longer followup and radiographic evidence will be necessary to corroborate or refute these initial observations.

[Penile fracture: report of a case]

Traumatic rupture of the corpus cavernosum of the penis is rare, and has been reported infrequently. We present a case with this type of trauma, with immediate surgical management, with good morphologic and functional results.

Review of Cleveland Clinic experience with penile fracture

OBJECTIVES

Fracture of the penis is an uncommon injury that results from trauma to the erect penis, usually during sexual intercourse. In some cases, the urethra is injured as well. To determine the outcome of immediate surgical management, we reviewed the cases of 8 patients with fracture of the penis who presented to the Cleveland Clinic from 1992 to 1998.

METHODS

Trauma was encountered during intercourse in all our patients. A concomitant urethral injury was found in 3 cases (38%); 1 was a complete disruption, and the other 2 were partial injuries. Patients were treated with immediate surgical exploration and repair, with preoperative urethrography in patients suspected of having a urethral injury.

RESULTS

All patients had a successful outcome, with preservation of sexual function and without significant penile curvature. Patients with urethral injuries reported normal voiding without the need for additional procedures.

CONCLUSIONS

Immediate surgical repair offers complete recovery for patients with penile fracture in most cases, even in the presence of urethral injury. We present our recommendations for treatment of this condition.

Penile fractures and our treatment policy

To evaluate our diagnosis and treatment policy of penile fractures, we reviewed 13 cases treated between August 1992 and August 1995. In ten patients early surgical correction, in one patient an elective surgical intervention was carried out. Two patients with minimal haematoma were suggested to undergo conservative treatment, but only one of them came to the control examination and he complained of fixed induration, pain and mild deviation in erection. In the group of early surgical repair there was no complication. In a patient who had had a delayed procedure small induration and minimal deviation were found. In the light of these findings we think that in penile fractures early surgical repair produces the best results.

The hemodynamic pathophysiology of impotence following blunt trauma to the erect penis

A total of 19 patients provided a history of impotence following blunt trauma to the erect penis during intercourse or masturbation, or after accidents. Corporeal veno-occlusive dysfunction was the most common hemodynamic abnormality (16 of 19 patients, or 84%). A site-specific leak, which consisted of abrupt filling of the dorsal vein and/or corpus spongiosum from a focal site on the penile shaft, was demonstrated in 15 patients (79%). Cavernous artery insufficiency was found less often (7 of 19 patients, or 37%). A focal mid shaft cavernous artery occlusion was demonstrated in 5 patients (28%). It is hypothesized that the aforementioned hemodynamic abnormalities are caused by tunica and intracavernous vasculature injuries induced by the marked short-term pressure increases, which approach or exceed the tunica tensile strength during acute abrupt loading of the erect penis. This hypothesis is supported by direct recording of intracavernous pressures that exceeded 450 mm. Hg in response to angulation and manual compression of the penile shaft. Further evidence was created by a biomechanical model that was based on previously published intracavernous pressure--circumference patient data during dynamic infusion pharmacocavernosometry. Using a typical patient data set a 60% diminution of circumference at the site of abrupt loading was calculated to induce a 15% increase in circumference in the nonloaded portion of the penile shaft and an elevated intracavernous pressure exceeding 900 mm. Hg. The site-specific hemodynamic abnormalities were found to occur not only in patients with a classical penile fracture history but also in patients with injuries during masturbation or following accidents who had no acute penile swelling or ecchymosis. Thus, the erect penis is at risk for injury during any acute loading situation. It is likely that this erect trauma-induced hemodynamic pathology occurs more frequently than previously appreciated and that this type of impotence may be the underlying basis for many cases of idiopathic Peyronie's disease.

Fracture of penis: diagnosis and management

Fracture of the penis is a rupture of the rigid corporeal body. Nine consecutive patients with this malady were managed by an operative repair, which included degloving of the penis, evacuation of the hematoma, and closure of the corporeal tear. Postoperatively all patients reported excellent rigidity of a straight penis. We conclude that operative management of a fractured corporeal body is safe and effective.

New surgical approach for operative management of penile fracture and penetrating trauma

We have seen 2 cases of penile fracture and 2 of penetrating penile trauma without urethral injury surgically managed with an incision originally described for the operative treatment of venogenic impotence. This incision afforded excellent exposure of all three corporeal bodies and facilitated operative repair. Postoperative results were excellent with return of normal erectile function, minimal edema, and a well-healed, barely visible scar. This incision represents another operative approach for the surgical management of penile fracture and penetrating trauma when urethral injury is not present.

Penile fracture with urethral injury

A case of penile fracture secondary to a mishap during sexual intercourse is reported. The injury involved both corpora cavernosa and complete transection of the urethra. The injury was repaired with plastic reanastomosis of the corpora cavernosa and urethra. The result with limited followup was satisfactory. The diagnosis and treatment of this unusual injury are discussed.

Non iatrogenic penile trauma. Our experience

Autors report their experience concerning traumatic penile pathology observed in 13 Patients and the follow-up with particular attention to the micturition and erection.

Management of fracture of the penis in Qatar

We present 21 patients with fracture of the penis treated between July 1982 and July 1990. Eighteen patients were treated surgically, with good functional and morphological recovery; 3 refused surgery, 1 of whom had penile deformity and pain on erection. The literature is reviewed with respect to the necessity of different diagnostic and therapeutic options.

Fractures of the penis: therapeutic approach and long-term results

Injury to the external male genitalia is considered, with attention focused on accidental fracture of the corpora cavernosa (by coitus or masturbation). Such injuries are often complicated by urethral lesions. We present 13 patients with either simple or complicated fracture of the penis, all of whom were operated on between 2 h and 8 days following injury, with excellent functional results. The need for immediate surgery is emphasised, in order to avoid erectile failure and curvature, which are typical complications of conservative treatment. Surgery consists of complete evacuation of haematoma, curettage and repair of the albuginea. If the fracture is associated with urethral disruption, the latter is also repaired.

Traumatic rupture of the corpus cavernosum

Penile fracture is a rare entity. Twelve patients with penile fractures were treated surgically with a very low complication rate. Our results were compared with those reported in the literature.

Traumatic rupture of corpus cavernosum

Penile fracture is a rare entity. Twelve patients with penile fractures were treated surgically with a very complication rate. Our results were compared with those reported in the literature.

Fracture of the penis and the result of surgical management

Twenty-nine patients with fracture of the penis were treated between January 1983 and January 1987. The mean age was 26 years (range 18-61 years) and 25 of them (86.2 per cent) were single. The first four patients were managed conservatively with bad results in three cases. Immediate exploration with repair of the tear of the tunica albuginea was carried out in 25 patients, who all had excellent results with retained potency and only mild pain during early intercourse that disappeared within the first 4 months. Urethral injury in association with fracture of the penis was not seen in this series. In view of the good results we recommend immediate surgical repair in cases of fracture of the penis.