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Wirjopranoto S. Penile hematoma mimicking penile fracture in a child. Asian J Surg 2024; 47:2522-2523. [PMID: 38378424 DOI: 10.1016/j.asjsur.2024.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Soetojo Wirjopranoto
- Department of Urology, dr. Soetomo and Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia; Dr. Soetomo General-Academic Hospital, Surabaya, Indonesia.
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Agostini E, Vinci A, Bardhi D, Ingravalle F, Muselli M, Milanese G. Improving clinical diagnostic accuracy and management of False penile fractures characterizing typical clinical presentation: a systematic review and meta-analysis. World J Urol 2023; 41:1785-1791. [PMID: 37326652 PMCID: PMC10352434 DOI: 10.1007/s00345-023-04456-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/20/2023] [Indexed: 06/17/2023] Open
Abstract
PURPOSE False penile fractures (FPF) represent a rare sexual emergency characterized by blunt trauma of penis in the absence of albuginea's injury, with or without lesion of dorsal penile vein. Their presentation is often indistinguishable from true penile fractures (TPF). This overlapping of clinical presentation, and lack of knowledge about FPF, can lead surgeons often to proceed directly to surgical exploration without further examinations. The aim of this study was to define a typical presentation of false penile fractures (FPF) emergency, identifying in absence of "snap" sound, slow detumescence, penile shaft ecchymosis, and penile deviation main clinical signs. METHODS We performed a systematic review and meta-analysis based on Medline, Scopus and Cochrane following a protocol designed a priori, to define sensitivity of "snap" sound absence, slow detumescence and penile deviation. RESULTS Based on the literature search of 93 articles, 15 were included (73 patients). All patients referred pain, most of them during coitus (n = 57; 78%). Detumescence occurred in 37/73 (51%), and all patients described detumescence occurrence as "slow". The results show that single anamnestic item have a high-moderate sensibility in the diagnosis of FPF, and the highest sensitive item was penile deviation (sensibility = 0.86). However, when more than one item is present, overall sensitivity increases greatly, closing to 100% (95% Confidence Interval 92-100). CONCLUSION Surgeons can consciously decide between additional exams, a conservative approach, and rapid intervention using these indicators to detect FPF. Our findings identified symptoms with excellent specificity for FPF diagnosis, giving clinicians more useful tools for making decisions.
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Affiliation(s)
- Edoardo Agostini
- Department of Urology, "IRCCS-INRCA" Hospital, 60127, Ancona, Italy
| | - Antonio Vinci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133, Rome, Italy
- Hospital Health Management Area, Local Health Authority "Roma 1", 00133, Rome, Italy
| | - Dorian Bardhi
- Post-Graduate School of Hygiene and Preventive Medicine, University of L'Aquila, 67100, L'Aquila, Italy
- Department of Life, Health and Environmental Science, University of L'Aquila, Piazzale Salvatore Tommasi, 1, 67100, L'Aquila, Italy
| | - Fabio Ingravalle
- Hospital Health Management Area, Local Health Authority "Roma 6", 00041, Albano Laziale, Italy
| | - Mario Muselli
- Department of Life, Health and Environmental Science, University of L'Aquila, Piazzale Salvatore Tommasi, 1, 67100, L'Aquila, Italy.
| | - Giulio Milanese
- Post-Graduate School of Urology, Polytechnic University of Marche, 60121, Ancona, Italy
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3
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Abstract
Penile fracture is a urologic injury with an etiology that varies based on the cultural milieu. Diagnosis can be made based on history and physical examination alone. Patients should be evaluated with RUG or cystoscopy when urethral injury is suspected. Ultrasound or MRI is a helpful adjunct when the diagnosis is unclear, and can assist in identifying the location of the rupture. Surgical management is favored over conservative measures to improve outcomes. Delayed surgical repair may not be inferior to immediate intervention.
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Affiliation(s)
- Allen Simms
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Nima Baradaran
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Tom F Lue
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
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Dias-Filho AC, Fregonesi A, Martinez CAT, Pimentel ES, Riccetto CLZ. Can the snapping sound discriminate true from false penile fractures? Bayesian analysis of a case series of consecutively treated penile fracture patients. Int J Impot Res 2019; 32:446-454. [DOI: 10.1038/s41443-019-0199-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 11/09/2022]
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Affiliation(s)
- Donna Napier
- Department of Medical Imaging; Royal Brisbane and Women's Hospital, Herston; Brisbane Australia
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Truong H, Ferenczi B, Cleary R, Healy KA. Superficial Dorsal Venous Rupture of the Penis: False Penile Fracture That Needs to be Treated as a True Urologic Emergency. Urology 2016; 97:e21-e22. [PMID: 27586514 DOI: 10.1016/j.urology.2016.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 08/10/2016] [Accepted: 08/22/2016] [Indexed: 11/17/2022]
Abstract
A 38-year-old man with history of repaired penile fracture presented with rapid detumescence, penile pain, and ecchymosis during vaginal sexual intercourse concerning for recurrent fracture. Surgical exploration revealed ruptured superficial dorsal vein of the penis, which was subsequently ligated. Patients with traumatic penile vascular injuries often present with clinical features indistinguishable from a true penile fracture. Gradual detumescence and an absence of characteristic popping sound may indicate a vascular injury but they cannot safely rule out a true penile fracture. Both true and false penile fractures require emergent surgical exploration and repair to prevent long-term complications.
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Affiliation(s)
- Hong Truong
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - Basil Ferenczi
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Ryan Cleary
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kelly A Healy
- Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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Vilson F, MacDonald S, Terlecki R. Contemporary Management of Penile Fracture: a Urologist’s Guide. CURRENT SEXUAL HEALTH REPORTS 2016. [DOI: 10.1007/s11930-016-0069-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Wong DP, Morrison BF, Mayhew RG, Reid GA, Aiken WD. A delayed foreskin-sparing approach to the management of penile fractures in uncircumcised Jamaican men. Int J Surg Case Rep 2015; 17:65-8. [PMID: 26551556 PMCID: PMC4701826 DOI: 10.1016/j.ijscr.2015.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/26/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022] Open
Abstract
Suitable for uncircumcised men with a penile fracture without urethral injury. An intentional delay of seven days is made before reassessment of the patient. In true penile fractures a “rolling sign” at the fracture site is felt at day seven. Focal incision over the fracture site under local anaesthesia is possible. The delayed approach mitigates against negative surgical exploration.
Introduction The traditional surgical approach to penile fracture is to perform a circumferential subcoronal degloving incision emergently to repair the injury. This approach necessitates circumcision to avoid foreskin complications. We present four men who had a delayed foreskin-sparing approach and discuss its advantages. Presentation of case Four of five uncircumcised patients who had suspected penile fractures secondary to coital injury, and without suspicion of concomitant urethral injury, had a delayed exploration, seven days after injury, utilizing an incision directly over the palpable haematoma, at the location of the tunical defect, thereby resulting in foreskin preservation. Two of 5 patients had repair under general anaesthesia, one under local anaesthesia and surgery was cancelled in another because upon reassessment at seven days he had normal erections and a normal penile examination. At follow up, all men had good functional and cosmetic outcomes. Discussion Uncircumcised patients with penile fractures, without suspicion of urethral injury, may undergo a delayed repair without prophylactic circumcision since there is minimal risk of foreskin complications. Delayed repair decreases the incidence of negative explorations by fostering a conservative approach in mimicking conditions such as superficial vein lacerations. It also enables the use of local anaesthesia in an elective ambulatory setting. Conclusion Delayed repair of penile fractures results in foreskin preservation, facilitates elective ambulatory care under local anaesthesia and decreases the incidence of negative surgical explorations.
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Affiliation(s)
- Dean P Wong
- The Department of Surgery, Radiology, Anaesthesia and Intensive care, Section of Surgery, Division of Urology, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
| | - Belinda F Morrison
- The Department of Surgery, Radiology, Anaesthesia and Intensive care, Section of Surgery, Division of Urology, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
| | - Richard G Mayhew
- The Department of Surgery, Radiology, Anaesthesia and Intensive care, Section of Surgery, Division of Urology, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
| | - Gareth A Reid
- The Department of Surgery, Radiology, Anaesthesia and Intensive care, Section of Surgery, Division of Urology, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
| | - William D Aiken
- The Department of Surgery, Radiology, Anaesthesia and Intensive care, Section of Surgery, Division of Urology, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
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Isolated penile urethral injury: A rare case following male coital trauma. Asian J Urol 2015; 2:175-178. [PMID: 29264140 PMCID: PMC5730709 DOI: 10.1016/j.ajur.2015.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 04/07/2015] [Accepted: 06/15/2015] [Indexed: 11/21/2022] Open
Abstract
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.
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Phillips EA, Esposito AJ, Munarriz R. Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center. Andrology 2015; 3:632-6. [DOI: 10.1111/andr.12043] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 02/27/2015] [Accepted: 03/25/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth A. Phillips
- Center for Sexual Medicine; Department of Urology; Boston Medical Center; Boston MA USA
| | - Anthony J. Esposito
- Department of Medicine; University of Washington School of Medicine; Seattle WA USA
| | - Ricardo Munarriz
- Center for Sexual Medicine; Department of Urology; Boston Medical Center; Boston MA USA
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Manimala NJ, Parker J. Evaluation and Treatment of Penile Thrombophlebitis (Mondor's Disease). Curr Urol Rep 2015; 16:39. [PMID: 25962547 DOI: 10.1007/s11934-015-0512-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Superficial penile thrombophlebitis or penile Mondor's disease (PMD) is an underreported condition that causes anxiety and embarrassment in affected men. Patients usually present with a smooth, cord-like induration on the dorsal penile shaft 1-7 days after prolonged or intensive sexual intercourse, but other presentations of disease and triggers for endothelial damage are possible. The condition is typically self-limited with expected spontaneous resolution within 4-8 weeks of initial presentation, and absolute diagnosis is usually not necessary with management including supportive care and pain control. However, when disease course is prolonged or there are concerning risk factors, it may be important to differentiate PMD from other conditions such as Peyronie's disease, hypercoagulability, blood stasis, genitourinary infection, and malignancy. History and physical are often sufficient to distinguish these conditions from PMD, but providers may employ ultrasound to assist with the diagnosis. If PMD does not spontaneously resolve, patients may be considered for thrombectomy, at which point histological analysis can confirm the diagnosis.
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Affiliation(s)
- Neil J Manimala
- Department of Urology, Morsani College of Medicine, University of South Florida, 2 Tampa General Cir, STC6, Tampa, FL, 33606, USA,
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