The impracticality of MRI for the diagnosis of atypical penile fracture in the emergency setting

MRI of the penis

This article reviews the anatomy and magnetic resonance imaging (MRI) appearance of the penis. The recommended technique for MRI of the penis is outlined, with discussion of the benefits and drawbacks to imaging the penis after artificial erection. Common penile pathologies are reviewed, with a summary of their clinical features, MRI appearance, and treatment. The ability to demonstrate the erectile bodies and vasculature helps to evaluate vascular pathologies such as priapism, Mondor disease, and cavernosal thrombosis. MRI is also a useful tool to assess for traumatic abnormalities of the penis, with the depiction of soft tissue anatomy and fascial layers allowing for evaluation of penile fracture and penile contusion. Malignant disease of the penis is also reviewed, including squamous cell carcinoma, urethral carcinoma, metastases, and rare neoplasms. Staging of these neoplasms is addressed, with discussion of how MRI can be used to assess the extent of tumor involvement. MRI also clearly demonstrates the tunica albuginea, which allows for evaluation of Peyronie's disease.

Role of sexual partner and social networking in fracture penis aetiology

Introduction

Fractured penis is a well-recognised urological emergency resulting from blunt trauma to the erect penis. The incidence and severity of penile fracture mostly relies on the method of sexual practice adopted by the couple which again depends on their psychosocial behaviour. The aim of this study was to analyse the different circumstances that accompany this injury in relation to severity, such as associated urethral injury, and to address the contribution of the patients’ partners in possible aetiologies and prevalences.

Methods

A prospective observational study over two years of all patients presenting to our institution with a fractured penis. All patients who were subjected to detailed history and clinical examination, which included educational status, profession and access to internet. The patients’ partners were asked the same questions as well as a sexual behaviour questionnaire to grade their level of sexual appetite.

Results

Thirteen patients were included; all patients were married with an average age of 37. The coital positions associated with this injury were female on top position (four cases), T position (three cases), knee–elbow coital position (two), male superior coital position (two) and lateral coital position (one); one couple were unable to explain the exact position. Overall, 11/13 (85%) female partners showed moderate to high sexual appetite and only two (15.5%) showed low appetite. Out of the 26 patients and partners, only nine (34.6%) had a profession related to computers, but 16 (61.5%) of them had access to the internet.

Conclusions

High aggressive sexual behaviour may be a factor for vigorous sexual activity and increase the chance of penile injury. The exact role of social networking though not well established may precipitate more injury through the learning of different coital positions; ‘female on top position’ may be related to a higher incidence of fractured penis.

Alteration in the etiology of penile fracture in the Middle East and Central Asia regions in the last decade; a literature review

Penile fracture is a well-recognized, relatively uncommon medical condition and its etiology differs according to geographic area. In this review article, we evaluated literature reported in the past decade, aiming to verify whether there has been any change in the etiology of this condition. A literature review was done for studies published in the past 10 years and focusing on the etiology of penile fracture. Inclusion criteria comprised articles in English language, of sample size more than 10 patients and originating from the Middle East and Central Asia. Data relating to the studied population, etiology of penile fracture, clinical presentation, investigations, management, and outcome was analyzed. One thousand six hundred and twenty-nine patients from 21 original articles were included in the study. The mean age ± standard deviation of the patients was 33.3 ± 3.23 years. Etiologies of penile fracture were vigorous sexual intercourse, manual bending of erect penis, vigorous masturbation, rolling over in bed and blunt trauma in 41%, 29%, 10%, 14% and 6% patients, respectively. Treatment choices were surgery and conservative, in 1580 (95%), 83 (5%) patients, respectively. A higher incidence of complications was found in conservatively treated patients. As a conclusion, in the last 10 years, vigorous sexual intercourse was the commonest etiology of penile fracture in the Middle East and Central Asia regions. Surgery remains the preferred treatment option for patients diagnosed with penile fracture.