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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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Hughes S, Elbaroni W, O'Donoghue J, Williams M. Atypical presentation of a vertical penile fracture. BMJ Case Rep 2021; 14:14/6/e243353. [PMID: 34187802 DOI: 10.1136/bcr-2021-243353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sam Hughes
- Urology, Yorkshire and the Humber Postgraduate Deanery, York, UK
| | - Wissam Elbaroni
- Urology, Belfast City Hospital Health and Social Services Trust, Belfast, UK
| | - John O'Donoghue
- Urology, Southern Health and Social Care Trust, Portadown, UK
| | - Marc Williams
- Radiology, Southern Health and Social Care Trust, Portadown, UK
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Sharma G, Mandal S, Bhowmik P, Gupta P, Bahal B, Sharma PK. Sexual function outcomes and risk factors of erectile dysfunction after surgical repair of penile fracture. Turk J Urol 2020; 47:106-112. [PMID: 33052833 DOI: 10.5152/tud.2020.20311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022]
Abstract
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.
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Affiliation(s)
- Gaurav Sharma
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, India
| | - Soumendranath Mandal
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, India
| | - Prasenjit Bhowmik
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, India
| | - Prashant Gupta
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, India
| | - Bandhan Bahal
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, India
| | - Pramod Kumar Sharma
- Department of Urology, Calcutta National Medical College & Hospital, Kolkata, India
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Yilmazel FK, Sam E, Altay MS, Cinislioglu AE, Sam E, Delice O, Karabulut I. Surgical results in penile fracture: Our single center experience. Am J Emerg Med 2020; 44:184-186. [PMID: 33041121 DOI: 10.1016/j.ajem.2020.08.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Penile fracture arises as a result of a unilateral or bilateral rupture of the tunica albuginea of the corpus cavernosum. It is a rare condition that requires urgent surgical intervention. In this study, we aimed to determine the effectiveness of surgical treatment in penile fracture and its effect on complications. METHODS The data of 21 patients who were admitted to the emergency department of our clinic between 2012 and 2019 and underwent emergency surgical repair with the diagnosis of penile fracture were collected retrospectively. The diagnosis of penile fracture was established by anamnesis and physical examination. Age, etiology, duration from trauma to surgery, physical examination findings,length and localization of the tunica albuginea defect, length of hospital stay, and postoperative first-, third- and sixth-month follow-up results were analyzed. Erectile function was evaluated using the International Index of Erectile Function (IIEF-5). Complications such as penile curvature, penile nodule and painful erection were evaluated. RESULTS The mean age of the patients was 36.8 ± 8.3 years. The most common reason of penile fracture was manually bending the penis for detumescence. All patients underwent surgery. The mean duration from trauma to surgery was 7.6 ± 3.1 h. The mean length of the tunica albuginea defect was 11 ± 2.5 mm. The mean length of hospital stay was 2.5 ± 0.5 days. The mean IIEF-5 scores in the postoperative first, third and sixth months were 20.5 ± 2.6, 22 ± 2.2, 22.1 ± 1.7, respectively. CONCLUSION Penile fracture is a urological emergency, and timely surgery is an effective treatment method for preventing postoperative complications.
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Affiliation(s)
- Fatih Kursat Yilmazel
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey
| | - Emre Sam
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey.
| | - Mehmet Sefa Altay
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey
| | - Ahmet Emre Cinislioglu
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey
| | - Emel Sam
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey
| | - Orhan Delice
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Emergency Medicine, Erzurum, Turkey
| | - Ibrahim Karabulut
- University of Health Sciences, Erzurum Regional Training and Research Hospital, Department of Urology, Erzurum, Turkey
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Abstract
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.
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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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Dell'Atti L, Scarcella S, Tallè M, Polito M, Galosi AB. Simultaneous curvature correction at the time of the penile fracture repair: surgical and functional outcomes. Res Rep Urol 2019; 11:105-110. [PMID: 31114766 PMCID: PMC6489630 DOI: 10.2147/rru.s191997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: After a penile fracture (PF), an early surgical exploration and defect closure of the lesions are recommended to prevent long-term complications. However, postoperative unsatisfactory penile curvatures are frequent in the literature. In this study, we wished to present surgical outcomes of PF after surgical repair approach with an early intraoperative curvature correction and update our series with postoperative follow-up. Patients and methods: An institutional retrospective review study of 36 patients undergoing surgical treatment for PF was performed. Mean age of patients was 53.2 years. All surgical explorations were performed within 12 hours after the traumatic event. The surgical repair with a contemporary penile plication was then made to straighten the tunica angulations in patients with curvature greater than 30°, using 2– 3 pairs of 2–0 absorbable suture of polydioxanone. Results: The length of the tear ranged from 8 to 20 mm. 77.7% of the patients required a correction of the cavernous body deviation. No early complications occurred in any case. The median patient stays in the hospital was 3.4 days. At a mean follow-up of 20.6 months, all patients were able to insert the penis in the partner’s vagina, and were satisfied overall with sexual intercourse; three patients (10.7%) reported residual pain and discomfort for the knots of the sutures. Conclusions: An early intraoperative curvature correction may be used for a variety of angulation deformities and severe degrees of deviations secondary to a repair after penile trauma, and may be helpful in preventing postoperative morbidity.
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Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Simone Scarcella
- Department of Urology, Polytechnic University of Marche, Ancona, Italy
| | - Matteo Tallè
- Department of Urology, Polytechnic University of Marche, Ancona, Italy
| | - Massimo Polito
- Andrology Unit, University Hospital "Ospedali Riuniti", Ancona, Italy
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Naouar S, Boussaffa H, Braiek S, El Kamel R. Management of penile fracture: Can it wait? AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Aikawa K, Kimura T, Koike Y, Yamada H, Egawa S. [CLINICAL PRESENTATION AND OUTCOMES OF PENILE FRACTURE: RETROSPECTIVE ANALYSIS OF 16 PATIENTS]. Nihon Hinyokika Gakkai Zasshi 2018; 109:204-207. [PMID: 31631083 DOI: 10.5980/jpnjurol.109.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Background) Penile fracture as a result of sexual activity is exceedingly rare. Therefore, few studies have investigated it specifically in Japan. (Methods) We evaluated the clinical features and complications of all patients with penile fractures treated at Jikei University Hospital between 2005 and 2017. A total of 16 patients were identified and their etiologies, symptoms, treatment strategy, operative approach, and complications were reviewed. (Results) The median patient age was 41 years (range: 22-67). We were able to identify the etiology in 15 patients: 5 patients (31%) had suffered the fracture during sexual intercourse and 4 (25%) during masturbation. All patients were not suspected of having urethral injury. Eight patients underwent magnetic resonance imaging (MRI) prior to surgical repair. Disruption of tunica albuginea could be identified in all 7 patients with decent descriptions of the findings recorded for review. All patients underwent surgery, and the ruptured tunica albuginea was repaired. None of the patients developed erectile dysfunction (ED) but 1 patient (6%) had postoperative penile curvature. (Conclusions) Penile fracture most frequently occurred during sexual intercourse and masturbation. Our series had no ED, but longer follow-up is needed to draw definitive conclusions.
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Affiliation(s)
- Koichi Aikawa
- Department of Urology, Jikei University School of Medicine
| | | | - Yusuke Koike
- Department of Urology, Jikei University School of Medicine
| | - Hiroki Yamada
- Department of Urology, Jikei University School of Medicine
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine
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Zare Mehrjardi M, Darabi M, Bagheri SM, Kamali K, Bijan B. The role of ultrasound (US) and magnetic resonance imaging (MRI) in penile fracture mapping for modified surgical repair. Int Urol Nephrol 2017; 49:937-945. [DOI: 10.1007/s11255-017-1550-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/20/2017] [Indexed: 10/20/2022]
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11
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Injury to the male external genitalia: a comprehensive review. Int Urol Nephrol 2017; 49:553-561. [DOI: 10.1007/s11255-017-1526-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
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MRI of penile fracture: what should be a tailored protocol in emergency? Radiol Med 2016; 121:711-8. [DOI: 10.1007/s11547-016-0651-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
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The role of ultrasonography in the diagnosis and management of penile trauma. J Ultrasound 2016; 19:161-6. [PMID: 27635160 DOI: 10.1007/s40477-016-0195-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE In this prospective study, we studied the role of ultrasonography (US) in the diagnosis and management of penile trauma. METHODS Between 2007 and 2014, 14 patients (mean age 39 years) with suspected penile fracture underwent US examinations. Almost all patients had a history of injury during sexual intercourse or manipulation of the penis. US examinations were performed in transversal and longitudinal planes starting at the level of the glans and moving down to the base of the penis. Color-Doppler was used to identify the vascular pattern or to see any abnormal vascularity. RESULTS The most common blunt injury to the penis that occurred in nine patients was penile fracture due to rupture of the corpus cavernosum. A tear occurred in only one of the corpora cavernosa. US showed an irregular hypoechoic or hyperechoic defect at the cavernosal rupture site. Four patients presented an injury to the subtunical venous plexus in the absence of complete tunical disruption. One patient had urethral rupture with inability to urinate and apparent urethrorrhagia. Ten patients underwent surgical operation, while four patients were observed and discharged after 2 days. Mean follow-up was 32 months (range 3-58). After 8 to 12 weeks, all of them were able to be sexually active as before. Angulations of penis persisted in one patient. CONCLUSION US may be the preferred imaging technique for evaluation of penile fracture before surgery. It is easy to perform, non-invasive, widely available, and inexpensive, although it requires an experienced team.
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Abstract
MRI of a 21-year-old man with a penile fracture demonstrated disruption of the tunica albuginea and adjacent hematoma. Both MRI and subsequent retrograde uretrogram showed that the urethra was not injured. The imaging findings were confirmed at surgery, and the penis was successfully repaired.
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Guler I, Ödev K, Kalkan H, Simsek C, Keskin S, Kilinç M. The value of magnetic resonance imaging in the diagnosis of penile fracture. Int Braz J Urol 2015; 41:325-8. [PMID: 26005975 PMCID: PMC4752097 DOI: 10.1590/s1677-5538.ibju.2015.02.20] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 07/28/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose We studied the use of magnetic resonance imaging in the diagnosis of penile fracture. Materials and Methods Between 1997 and 2012, fifteen patients (age range 17-48 years, mean age 37 years) with suspected penile fracture underwent MRI examinations. Ten patients were injured during sexual intercourse, whereas four patients were traumatized by non-physiological bending of the penis during self manupilation, one patient was traumatized falling from the bed. Investigations were performed with 1.5T MR unit. With the patient in the supine position, the penis was taped against the abdominal wall and surface coil was placed on the penis. All patients were studied with axial, coronal, sagittal precontrast and postcontrast T1-weighted TSE(TR/TE:538/13 msn) and T2-weighted TSE(5290/110 msn) sequences. All patient underwent surgical exploration. The follow-up ranged from 3 months to 72 months. Clinically all patients showed normal healing process without complications. In 11 patients a shortening and thickening of tunica albuginea was observed. Three patients have post traumatic erectil disfunction. Results In all patient corpus cavernosum fractures were clearly depicted on a discontinuity of the low signal intensity of tunica albuginea. These findings were most evident on T1WI and also depicted on T2W sequences. Images obtained shortly after contrast medium administration showed considerable enhancement only in rupture site. Subcutaneous extratunical haematoma in all patients were also recognizable on T2 WI. MRI findings were confirmed at surgery. Conclusions Magnetic resonance imaging is of great value for the diagnosis of penile fracture. Furthermore this method is well suited for visualising the post-operative healing process
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Affiliation(s)
- Ibrahim Guler
- Department of Radiology, Konya Research and Education Hospital, Konya, Turkey
| | - Kemal Ödev
- Department of Radiology Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Havva Kalkan
- Department of Radiology Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Cihan Simsek
- Department of Radiology Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Suat Keskin
- Department of Radiology Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Mehmet Kilinç
- Department of Urology, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
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Majzoub AA, Canguven O, Raidh TA. Alteration in the etiology of penile fracture in the Middle East and Central Asia regions in the last decade; a literature review. Urol Ann 2015; 7:284-8. [PMID: 26229311 PMCID: PMC4518360 DOI: 10.4103/0974-7796.157973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 02/16/2015] [Indexed: 11/09/2022] Open
Abstract
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.
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Affiliation(s)
- Ahmad A Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Onder Canguven
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Talib A Raidh
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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Mahapatra RS, Kundu AK, Pal DK. Penile Fracture: Our Experience in a Tertiary Care Hospital. World J Mens Health 2015; 33:95-102. [PMID: 26331126 PMCID: PMC4550602 DOI: 10.5534/wjmh.2015.33.2.95] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/26/2015] [Accepted: 04/28/2015] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Penile fracture is rare, but it is a urological emergency that always requires immediate attention. Moreover, penile fracture has been reported more frequently in recent years. It may have devastating physical, functional, and psychological consequences if not properly managed in time. MATERIALS AND METHODS The objective of this study was to highlight the causes, clinical presentation, and outcomes of cases of penile fracture. This was a prospective observational study extending from November 2012 to November 2014. Each patient underwent a thorough clinical evaluation and received proper treatment. RESULTS Twenty patients with penile fracture, aged 19 to 56 years (mean, 28 years) were evaluated in this study. Vaginal intercourse was the most common mechanism of injury. Most of the patients (95%) were diagnosed clinically with a proper history and clinical examination. Nineteen patients were treated surgically. The patients underwent six months of follow-up, and were evaluated with local examinations, questionnaires, and colour Doppler ultrasonography as necessary. CONCLUSIONS Although penile fracture is an under-reported urological emergency, its incidence is increasing. It is usually diagnosed based on a clinical examination, but ultrasonography can be very helpful in diagnosis. Especially in cases where treatment is delayed, surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications.
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Affiliation(s)
- Rajkumar Singha Mahapatra
- Department of Urology, Institute of Post-Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
| | - Anup Kumar Kundu
- Department of Urology, Institute of Post-Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
| | - Dilip Kumar Pal
- Department of Urology, Institute of Post-Graduate Medical Education and Research and SSKM Hospital, Kolkata, India
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Swanson DEW, Polackwich AS, Helfand BT, Masson P, Hwong J, Dugi DD, Martinez Acevedo AC, Hedges JC, McVary KT. Penile fracture: outcomes of early surgical intervention. Urology 2014; 84:1117-21. [PMID: 25443914 DOI: 10.1016/j.urology.2014.07.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/01/2014] [Accepted: 07/18/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To report a series of penile fractures, describing preoperative evaluation, surgical repair, and long-term outcomes. PATIENTS AND METHODS Medical records from Northwestern Memorial Hospital and Oregon Health & Science University from 2002 to 2011 were reviewed. Clinical presentation, preoperative evaluation, time from injury, mechanism and site of injury, and presence of urethral injury were assessed. Outcomes including erectile dysfunction, penile curvature, and voiding symptoms were evaluated using International Prostate Symptom Score and International Index of Erectile Function scores. RESULTS Twenty-nine patients with 30 separate episodes of penile fractures presenting to the emergency room were identified. Mean patient age was 43 ± 9.6 years. The time from presentation to the initiation of surgery was 5.5 ± 4.4 hours. Mechanism of injury was intercourse in 26 of 30 fractures with the remaining attributed to masturbation or "rolling over." Immediate surgical repair was offered to all patients. Twenty-seven patients underwent surgery. Urethral injury was noted in 5 of the 27. The site of fracture was at the proximal shaft in 11, mid shaft in 12, and distal shaft in 4 patients. The mean follow-up period was 14.3 ± 15.8 weeks. Nine patients reported new mild erectile dysfunction or penile curvature. One patient reported new irritative voiding symptoms. CONCLUSION The most common mechanism of penile fracture was from sexual intercourse, and frequent concomitant urethral injuries were observed. The frequency of concomitant urethral injury was higher than in previous studies. Although we observed high incidence of erectile dysfunction or penile curvature with early surgical repair, we retain it as the favored approach.
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Affiliation(s)
| | | | - Brian T Helfand
- Division of Urology, Department of Surgery, NorthShore University Health, Glenview, IL
| | - Puneet Masson
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - James Hwong
- Department of Urology, Brigham and Woman's Hospital, Boston, MA
| | - Daniel D Dugi
- Department of Urology, Oregon Health & Science University, Portland, OR
| | | | - Jason C Hedges
- Department of Urology, Oregon Health & Science University, Portland, OR.
| | - Kevin T McVary
- Division of Urology, Southern Illinois University of Medicine, Springfield, IL
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Kurkar A, Elderwy AA, Orabi H. False fracture of the penis: Different pathology but similar clinical presentation and management. Urol Ann 2014; 6:23-6. [PMID: 24669117 PMCID: PMC3963338 DOI: 10.4103/0974-7796.127015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 12/12/2013] [Indexed: 02/05/2023] Open
Abstract
Introduction: Penile fracture is the most common presentation of acute penis. Rupture of the superficial dorsal penile vein (s) may mimic penile fractures with similar clinical presentation but with intact corporeal bodies. Our aim of the study is to highlight superficial dorsal penile vein (s) injury as true emergency with better prognosis. Subjects and Methods: Sixty-eight patients with suspected penile fractures presented to our hospital between June 2007 and January 2013. Out of these, 11 patients showed intact tunica albuginea on exploration with injured dorsal penile vein (s) identified. Records of such 11 cases were reviewed regarding age, etiology, symptoms, physical signs, findings of surgical exploration and post-operative erectile function. Results: All 11 patients were injured during sexual intercourse and presented with penile swelling and ecchymosis and gradual detumescence. Mild penile pain was encountered in 5 cases and the “snap” sound was noted in 2 cases. Examination revealed no localized tenderness, or tunical defect. All the patients regained penile potency without deformity after surgical ligation of the severed vessels. One patient developed penile hypoesthesia. Conclusion: Although the classic “snap” sound and immediate detumescence are usually lacking in the symptomology of dorsal penile vein rupture, its clinical presentation can be indistinguishable from true penile fracture. Surgical exploration is still required to avoid missing tunical tear with possible future complications. The long-term outcome and prognosis are excellent.
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Affiliation(s)
- Adel Kurkar
- Department of Urology, Assiut University, Asyut 71516, Egypt
| | - Ahmad A Elderwy
- Department of Urology, Assiut University, Asyut 71516, Egypt
| | - Hazem Orabi
- Department of Urology, Assiut University, Asyut 71516, Egypt
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Abstract
MRI of the penis is an expensive test that is not always superior to clinical examination or ultrasound. However, it shows many of the important structures, and in particular the combination of tumescence from intracavernosal alprostadil, and high-resolution T(2) sequences show the glans, corpora and the tunica albuginea well. In this paper we summarise the radiological anatomy and discuss the indications for MRI. For penile cancer, it may be useful in cases where the local stage is not apparent clinically. In priapism, it is an emerging technique for assessing corporal viability, and in fracture it can in most cases make the diagnosis and locate the injury. In some cases of penile fibrosis and Peyronie's disease, it may aid surgical planning, and in complex pelvic fracture may replace or augment conventional urethrography. It is an excellent investigation for the malfunctioning penile prosthesis.
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Affiliation(s)
- A Kirkham
- University College Hospital, 235 Euston Road, London, UK.
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Tijani KH, Ogo CN, Ojewola RW, Akanmu NO. Increase in fracture of the penis in south-west Nigeria. Arab J Urol 2012; 10:440-4. [PMID: 26558065 PMCID: PMC4442948 DOI: 10.1016/j.aju.2012.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 06/21/2012] [Accepted: 07/09/2012] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To present our recent experience in the management of penile fracture. PATIENTS AND METHODS We present 21 cases of penile fracture managed at the two Federal-owned tertiary hospitals in two neighbouring states in south-west Nigeria between 2001 and 2011. The diagnosis was based mainly on a clinical evaluation. The treatment was surgical in patients who presented within 2 weeks of the fracture. The emphasis during the follow-up was on erectile function and micturition. RESULTS Seventeen patients presented within 48 h, two presented after a week, while two reported months later with penile deviation. The mean age of the patients was 26.4 years. The cause of fracture was sexual intercourse in 11 (52%) patients and forceful manipulation of the erect penis in 10 (48%). Thirteen (62%) of all injuries occurred in the last 2 years of the study, of which eight men were injured during rear entry with the woman on top (reverse coital) position. Six of the patients with reverse coital injuries reported trying the position after watching it on the Internet, specifically on their cellular phones. Eighteen patients had surgical treatment, with a satisfactory outcome. Two of the other three patients had penile deviation during erection. CONCLUSIONS The incidence and causes of penile fracture appear to have changed drastically over the last 2 years in our environment. The rapid demographic changes in south-west Nigeria are probably responsible. There appears to be a relationship between the cause of fracture and the use of the Internet, although that might be coincidental. Surgical repair, irrespective of the delay before intervention, usually offers a satisfactory outcome.
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Affiliation(s)
- Kehinde H Tijani
- Department of Surgery, Section of Urology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chidiebere N Ogo
- Department of Surgery, Section of Urology, Federal Medical Centre, Abeokuta, Nigeria
| | - Rufus W Ojewola
- Department of Surgery, Section of Urology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nurudeen O Akanmu
- Department of Anaesthesia, Lagos University Teaching Hospital, Lagos, Nigeria
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Abstract
The penis is a very sensitive organ and even minor injury or discomfort may cause a patient to seek emergency evaluation. Emergency practitioners must be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis, namely ischemic priapism, paraphimosis, and entrapment injury. Any penile trauma should be considered an emergency until proven otherwise. This article discusses emergent penile complaints in adults, with emphasis on the most serious and common conditions.
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Affiliation(s)
- Jeffrey Dubin
- Department of Emergency Medicine, Washington Hospital Center, Georgetown University School of Medicine, Washington, DC 20010, USA.
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Penile fracture: long-term results of surgical and conservative management. ACTA ACUST UNITED AC 2011; 71:491-3. [PMID: 21278611 DOI: 10.1097/ta.0b013e3182093113] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Penile fracture usually results from direct trauma to the erected penis. We evaluate the outcomes of surgical and conservative treatment. METHODS Between February 2000 and February 2007, 77 patients with mean age 29 ± 2.5 years (range, 20-57 years) with penile fracture were evaluated retrospectively. A total of 56 patients (group A) were treated with immediate surgical repair and 21 patients (group B) were treated conservatively as they refused surgical intervention. Data on erectile function and any penile sequel were obtained during follow-up using the International Index of Erectile Function (IIEF-15) questionnaire, local examination, and color Doppler ultrasonography reports. RESULTS Only 69 patients were available for median follow-up period of 20.8 months (range, 17-30 months), 51 patients of the group A and 18 of the group B. Injury involved unilateral and bilateral corporeal rupture in 50 and 6 cases, respectively. Concomitant urethral injury was detected in three cases. During follow-up, 49 cases (96%) of the surgical group (A) and 9 cases (50%) of the conservative group (B) reported erection adequate for intercourse, with no voiding dysfunction and no penile curvature. However, the remaining nine patients (50%) from the conservative group (B) reported erectile dysfunction and penile deviation. CONCLUSIONS Immediate surgical repair of the penile fracture gave good results and is superior to conservative treatment; however, we cannot distinguish false from true penile fracture accurately to determine on whom we can use the conservative treatment.
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Abstract
OBJECTIVES To present our experience with diagnosis and surgical management of penile fracture PATIENTS AND METHODS We present six cases of penile fracture managed at our unit between 2003 and 2008. The diagnosis was based on clinical presentation and physical examination. The treatment was surgical in all cases with Subcoronal circumferential degloving incision, evacuation of hematoma and reconstruction of the rupture with absorbable suture. RESULTS The clinical diagnosis of penile fracture was accurate in all six cases. All patients had a successful outcome, with preservation of erectile function CONCLUSION Penile fracture is a clinical diagnosis and immediate surgical repair offers complete recovery of sexual function.
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Affiliation(s)
- J E Mensah
- University of Ghana Medical School, Department of Surgery, PO Box 4236, Accra, Ghana
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Wood HM, Angermeier KW. Editorial comment. Urology 2010; 75:1356-7; author reply 1357. [PMID: 20513493 DOI: 10.1016/j.urology.2009.12.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 12/22/2009] [Accepted: 12/22/2009] [Indexed: 11/25/2022]
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Kirkham APS, Illing RO, Minhas S, Minhas S, Allen C. MR imaging of nonmalignant penile lesions. Radiographics 2008; 28:837-53. [PMID: 18480487 DOI: 10.1148/rg.283075100] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Magnetic resonance (MR) imaging is potentially useful in the assessment of many benign penile diseases. When T1- and T2-weighted sequences are used, MR imaging can clearly delineate the tunica albuginea and can be used to diagnose penile fracture and Peyronie disease; in both conditions, MR imaging may help refine the surgical approach. It is also useful in cases of priapism; in these cases, intravenously administered contrast material can help assess the viability of the corpora cavernosa and the presence of penile fibrosis. In the assessment of a penile prosthesis, MR imaging provides excellent anatomic information and is the investigation of choice. In the evaluation of erectile dysfunction, MR imaging has limited value, and for urethral stricture, it has not yet proved adequately superior to other modalities to justify its routine use.
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Affiliation(s)
- Alexander P S Kirkham
- Department of Imaging, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London NW1 2BU, England.
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Strunk T, Bastian PJ, Fechner G, Müller SC. Management of extended penile trauma with bilateral rupture of cavernosal bodies and complete urethral disruption. Int J Clin Pract 2008; 62:657-8. [PMID: 18324956 DOI: 10.1111/j.1742-1241.2006.01017.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Turpin F, Hoa D, Faix A, Filhastre M, Mazet N, Rouanet de Vigne Lavit J. IRM de la verge : intérêt dans le bilan post-traumatique. ACTA ACUST UNITED AC 2008; 89:303-10. [DOI: 10.1016/s0221-0363(08)93004-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Feki W, Derouiche A, Belhaj K, Ouni A, Ben Mouelhi S, Ben Slama MR, Ayed M, Chebil M. False penile fracture: report of 16 cases. Int J Impot Res 2007; 19:471-3. [PMID: 17554393 DOI: 10.1038/sj.ijir.3901574] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We determined the value of diagnostic and therapeutic approaches of false penile fractures and the outcome of treatment. We retrospectively reviewed 16 cases of presumed penile fracture with a negative surgical exploration. Clinical presentation, technique of treatment and outcome were noted. The mean age was 39 years (17-64). Nine patients were injured during sexual intercourse. All the patients presented with the presumptive diagnosis of penile fracture. False penile fracture was evoked in one patient presenting a new erection. Surgical penile exploration was carried out for all the patients without any radiological explorations. It revealed nonspecific dartos bleeding in 10 cases and avulsed superficial dorsal vein in six cases requiring venous ends ligation. All the patients regained penile appearance and potency. We can hardly distinguish false penile fracture from 'true' penile fracture with certainty either clinically or radiologically, thus, surgical exploration is mostly necessary. The prognosis is excellent.
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Affiliation(s)
- W Feki
- Department of Urology, Charles Nicolle Hospital, Tunis, Tunisia.
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Abstract
PURPOSE OF REVIEW Diseases of the penis are common, and the aim now is the preservation of function and cosmesis of the penis using modern penile reconstructive techniques. Penile cancer, Peyronie's disease and trauma are the three pathologies assessed. RECENT FINDINGS Modern conservative organ-sparing surgery in penile cancer has shown that good oncological control can be gained by 2 mm margins that allow preservation of sexual function. Early intervention in the traumatic penis gives better results whereas the Nesbit operation is still the gold standard for Peyronie's disease as the quest for an alternative graft to saphenous vein continues. SUMMARY The current operations of choice in penile reconstruction are glansectomy and skin grafting to fashion a neoglans in penile cancer and the Nesbit operation or saphenous grafting for Peyronie's disease.
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Affiliation(s)
- David J Ralph
- Institute of Urology, University College London, 252 Euston Road, London, UK.
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Bibliography. Current world literature. Reconstructive surgery. Curr Opin Urol 2006; 16:460-3. [PMID: 17053527 DOI: 10.1097/mou.0b013e328010dc58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McEleny K, Ramsden P, Pickard R. Penile fracture. ACTA ACUST UNITED AC 2006; 3:170-4; quiz 175. [PMID: 16528289 DOI: 10.1038/ncpuro0433] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 01/13/2006] [Indexed: 11/09/2022]
Abstract
BACKGROUND A 23-year-old man presented with a painful penis following sexual intercourse. On examination he had a swollen, bruised penis that was tender on palpation, most markedly on the right lateral aspect. INVESTIGATIONS Urinalysis. DIAGNOSIS Rupture of right corpus cavernosum. MANAGEMENT Immediate surgical repair.
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Zaman ZR, Kommu SS, Watkin NA. The management of penile fracture based on clinical and magnetic resonance imaging findings. BJU Int 2005; 96:1423-4. [PMID: 16287472 DOI: 10.1111/j.1464-410x.2005.05982_4.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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