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

Atypical Presentation of a Penile Fracture With Unilateral Corpora Cavernosa and Urethral Injury

A penile fracture is a rare but urgent urologic emergency that requires immediate surgical correction to preserve erectile function. It results from a rupture of the tunica albuginea of one or both corpora cavernosa. Patients classically will present with a history of recent sexual activity and a sudden "snap," followed by detumescence, pain, and swelling of the phallus. The rupture of the tunica albuginea typically happens ventrolaterally along the penile shaft, as the tunica albuginea thins at this location, especially during erections. In this report, we present a case of a penile fracture with a rupture of the tunica albuginea at an unusual location in the distal phallus between the corpora cavernosa and corpora spongiosum.

The presentation and outcomes of penile fracture with associated urethral injury: A systematic literature review

PURPOSES

Penile fracture (PF) with associated urethral injury has been described as a rare condition yet a serious urological emergency. We conducted this systematic review to address the current literature concerning the etiology, presentations, intra-operative findings, site of injury, and complications of PF with associated urethral injury, Materials and Methods: The present systematic review was limited to human-based studies published in English language, and reporting clinical data on PF cases with associated urethral injuries. A comprehensive search of the literature was conducted on five electronic databases from their inception to May 2022: Medline via PubMed, Web of Science, Google Scholar, Scopus, and EBSCO host.

RESULTS

A total of 15 studies were included encompassing 1671 patients with PF. Out of 1665 patients with PF retrieved from the case series studies, 65 patients had associated urethral injuries giving a point prevalence of 3.9%. The vast majority of the patients had blood on the meatus and hematuria suggestive of urethral injury (57/59; 96.6%). Forty patients had partial urethral disruption and the rest of the patients had a complete rupture. All patients received primary urethroplasty as the main modality of treatment. The median hospital stay was two days and the median duration of transurethral catheterization was 21 days. Five patients (8.5%) developed urethral stricture; other complications included penile curvature (6.7%), palpable fibrosis (6.7%), and erectile dysfunction (3.4%).

CONCLUSIONS

Urethral injuries are uncommon, but serious findings, in patients with PF. Primary urethroplasty appears to achieve satisfactory outcomes with a low incidence of short and long-term complications.

Severe penile fracture with bilateral corpus cavernosum rupture, complete urethral rupture and scrotal haematoma associated with sexual intercourse: A case report

INTRODUCTION AND IMPORTANCE

Despite the fact that a penile fracture is a rare emergency, it can cause morbidity in the patient, especially in terms of sexual life. If cases are not properly managed, irregularities in the penis will emerge, leading to more complicated problems. We present a case report of severe penile fracture associated with sexual intercourse.

CASE PRESENTATION

A 50-year-old man complained of soreness in his penis during sexual intercourse. The patient also has urethrorrhagia and is unable to urinate. Physical examination reveals the "Eggplant Deformity" in the penis. The operation was carried out and revealed bilateral corpus cavernosum rupture, complete urethral rupture, and ruptured Buck's fascia. The corpus cavernosum and other structures were repaired primarily, followed by an end-to-end anastomosis of the urethra. Four months later, the patient had no serious complaints, only a minor penis deviation. He can easily void and having intercourse.

CLINICAL DISCUSSION

In most situations, the penile fracture can be determined nearly entirely based on the patient's medical history and physical examination. In dubious circumstances, further tests such as ultrasonography and MRI can be conducted. If a penile fracture is discovered, surgery should be undertaken. Ruptures of the corpus cavernosum, tunica albuginea and Buck's fascia can be sutured primarily. The urethral can be reconstructed using an end-to-end anastomosis. Scrotal haematomas should be evacuated and drained to prevent persistent scrotal haematomas.

CONCLUSION

Immediate surgery in cases of severe penile fracture provides good outcomes for erectile function, micturition and sexual intercourse with minimal complications.