• Clinical science

Penile fracture

Abstract

Penile fracture refers to the traumatic rupture of the tunica albuginea and the corpora cavernosa of the penis. It is a rare condition that results from traumatic bending of the erect penis, typically during sexual intercourse or masturbation. Penile fractures usually present with acute pain and a cracking sound, accompanied by immediate loss of erection, as well as curving, swelling, and hematoma of the penis. In most cases, the diagnosis is established clinically, but imaging methods (e.g., ultrasound, MRI) may be needed in ambiguous cases. Retrograde urethrography is recommended in all cases of confirmed penile fracture to rule out concomitant urethral damage. Penile fracture is an acute urological emergency and requires immediate surgical treatment to avoid long-term complications, including abnormal curvature of the penis and erectile dysfunction.

Definition

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Etiology

  • Traumatic bending of the erect penis
    • During sexual intercourse; most commonly occurs with the woman on top
    • Aggressive masturbation methods

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Clinical features

  • Cracking, snapping, or popping sound caused by rupturing of the tunica albuginea and soft tissue
  • Immediate detumescence (loss of erection)
  • Pain; varies in intensity depending on severity of the injury
  • Pronounced soft tissue swelling, curving, and hematoma of the penis (“eggplant” appearance)
  • Blood at the urethral meatus in concomitant urethral injury

References:[1]

Diagnostics

The diagnosis of penile fractures is primarily clinical. Additional imaging is performed to diagnose ambiguous cases.

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Differential diagnoses

  • Rupture of the dorsal vein of the penis

References:[1]

The differential diagnoses listed here are not exhaustive.

Treatment

  • Surgical procedure
    • Exploration of the penis with evacuation of hematoma
    • Repair of possible urethral injury with insertion of a catheter for stenting purposes
    • Suture of rupture in the tunica albuginea
  • Postoperative measures
    • Pain medication; prophylactic oral antibiotics
    • Light compression dressing
    • 4 weeks of sexual abstinence (suppression of spontaneous erections with diazepam or stilboestrol may be considered)
    • Follow-up with retrograde urethrography in patients with urethral reconstruction upon removal of the urethral catheter after 2 weeks

Penile fracture is a urological emergency and requires immediate surgical treatment to restore functionality and minimize risk of long-term complications!

References:[1][2]

Complications

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We list the most important complications. The selection is not exhaustive.