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PENILE FRACTURE

Lakshay Chanana
Clinical Fellow, Emergency Medicine
LNWH NHS Trust
- @EMDidactic
OUTLINE
Story
Relevant Anatomy
Mechanism
Diagnosis and Imaging
Management and Complications
Evidence
Story

Young Male presented to the ED


BIBA with penile pain and swelling
Accompanied by his partner
Fall from Bed Heard a popping
sound
Obs Stable, Pain ++
Examination

Swelling
Tenderness
Hematoma
Bluish Black
discoloration

Eggplant deformity

Must look for blood in


Penile Fracture
Traumatic rupture of the tunica
albuginea of the corpora cavernosum

Happens only during erection as TA


thins from 2 mm to 0.5 - 0.25 mm
(Pressures >1500mm Hg)

Blunt trauma in flaccid state is not


considered as a fracture
Jack GS, Garraway I, Reznichek R, Rajfer J: Current treatment options for penile frac-
tures. Rev Urol 2004;6:114120.
MECHANISM

Sexual intercourse
Masturbation
Rolling over on the bed
Falling onto the erect penis
DIAGNOSIS
EGGPALNT DEFORMITY
Classic History
Audible popping sound (85%),
followed by pain (50%)
Rapid detumescence (95%),
Swelling and discoloration (90%).

Uretheral Injury More common when


both CC are injured
IMAGING
Often not needed but options include

USG
Cavernosography (time, expertise, and
equipment required, allergic reaction, corporal
fibrosis, and priapism)

Retrograde Urtethrogram (r/o uretehral injury)


MRI (very accurate but ?time, cost, availability)
MANAGEMENT
Non-Operative 30% complication rate.
Ice packs, Foley catheterization, and
anti-inflammatory medicines, erection-
inhibiting estrogens, penis splints,
antibiotics, and fibrinolytic agents

Operative 4% complication rate,


Hematoma evacuation and repair of the
defect
COMPLICATIONS
Uretheral Injury
Urethral stricture and urethral
cutaneous fistulae
Painful erections
Severe penile angulation
Arterial-venous fistulas, infected
hematomas, abscess formation, and
impotence/ED
EVIDENCE
Surgical Repair >>> Conservative

Delayed presentation (after days)


Surgical Repair is still highly
recommended

Good outcomes in 92% of patients


treated surgically versus only 59% in
those treated conservatively.
Take Home (Penile Fracture)
Rupture of Tunica Albuginea of CC
Mechanism Often Vigorous Intercourse
Diagnosis Clinical
Image equivocal cases to r/o uretheral
injury

Rx Pain Relief, Early Surgical Repair


(<8hrs) to prevent complications
Thank You
lakshay,.chanana@nhs.net

http://emdidactic.blogspot.co.uk/2015/
02/penile-fracture-is-it-possible.html