10/5/2023 0 Comments Penile fracture surgery![]() History and physical examination are, therefore, reliable enough to make a firm diagnosis and the added expense of these additional tests should be avoided. The operative findings in this series confirmed the clinical diagnosis in all cases, including the location of the tear. 8, 9, 10 However, the positive predictive values in these studies have been shown to be similar to that of history and clinical examination. Some investigators have recommended the use of ultrasound, carvernosography and magnetic resonance imaging to locate the site of the tunical tear before surgery. The diagnosis of penile fracture was predicted from the history and physical examination in all our patients. 5, 6 Other bizarre causes include rolling out of bed and striking a wall, hitting a toilet seat, being thrown against the knob of a saddle, rolling out of a chair onto the floor. This most commonly occurs during vaginal intercourse either in the ‘woman on top position’ when her entire weight lands on the erect penis or in the ‘missionary position’ when the penis misses the introitus and is thrust against the symphysis pubis or perineum.Ī variety of other causes of penile fracture have been reported, including bending during masturbation or after a sudden deliberate penile kneading and snapping to achieve detumescence, or unconscious nocturnal manipulation. The mechanism of injury is usually a direct blunt force causing a sudden bending of the erect penis. The fracture is usually followed by haematoma at the site of fracture that can spread to the scrotum, perineum and suprapubic area when Buck's fascia is disrupted. This reduction in thickness and associated loss of mobility make the tunica albuginea of the erect penis vulnerable to fracture. The mean follow up was 20 months (range 7 to 40).Īll the patients reported normal erection and sexual activity except one patient who at the last follow up visit has not attempted sexual intercourse due to the fear of re-fracture.ĭuring erection the engorgement of the corporeal bodies with blood thins out the surrounding tunica albuginea from 2mm to 0.5–0.25mm. There were no significant post operative problems and the average hospital stay was four days (range 3–6). The clinical diagnosis was confirmed at surgery in all cases The site of the fracture was in the distal third of the penis in 5 patients and at the penoscrotal junction in one patient All the tears in the tunica albuginea were unilateral and transverse with no urethral involvement One later admitted to being under the influence of marijuana when the incident occurred. Two patients claimed to have sustained the fracture while trying to tuck their erect penises into their pants. One patient sustained the fracture when he rolled over the erect penis in bed (to pick a mobile phone). Two of these three patients were having intercourse in the missionary position and one ‘the woman on top’ position. The injury was sustained during vaginal intercourse in three patients. The interval between injury and presentation ranged between 4 and 72 hours. We present our experience with penile fracture diagnosed solely on clinical findings and managed with immediate surgical repair. 4 Currently immediate surgical repair is the treatment of choice. Earlier reports on the management of this injury advocated conservative management with cold compresses and a variety of anti-inflammatory and fibrinolytic therapies. Others believe that there is a need for preoperative evaluation with carvernosography, retrograde urethrography or MRI. The above presentation is considered by many to be diagnostic. At the time of the fracture, the patient (and sometimes the sexual partner) typically hears a loud cracking noise associated with loss of erection, penile pain and swelling. The diagnosis of penile fracture is based on the patient's history and clinical findings. 3 Because of the rarity of this condition, the optimal diagnostic approach and management is still controversial. 2 In Middle Eastern countries, a large percentage is due to forceful bending of the erect penis to achieve detumescence, a practice known as ‘Taghaandan’. Vaginal intercourse is the most common known cause of penile fractures, with frequencies of 33–58% of all injuries. The true incidence is not known but is perhaps much higher than reported because many patients do not seek medical attention due to embarrassment or fear. This excludes penetrating and degloving injuries or amputation of the flaccid penis. Penile fracture is a relatively uncommon condition that is defined as the rupture of the corpus carvernosum and or the corpus spongiosum caused by blunt trauma to the erect penis.
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