Penile fracture: Difference between revisions
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==Background== | ==Background== | ||
*Tunica albuginea of one or both | [[File:Sobo 1909 571.png|thumb|Penis anatomy]] | ||
[[File:Gray1142.png|thumb|The human male urethra laid open on its anterior (upper) surface.]] | |||
[[File:Gray1155.png|thumb|Transverse section of the penis.]] | |||
*Tunica albuginea of one or both corpora cavernosa ruptures due to trauma to erect penis | |||
*Can be associated with urethral rupture and deep dorsal vein injury | *Can be associated with urethral rupture and deep dorsal vein injury | ||
*Unlikely to occur in blunt pelvic trauma with a flaccid penis | *Unlikely to occur in blunt pelvic trauma with a flaccid penis | ||
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==Clinical Features== | ==Clinical Features== | ||
*Penis is swollen, discolored, tender, and flaccid | *Penis is circumstantially swollen, discolored, tender, and flaccid | ||
*Cracking sound followed by pain, detumescence, swelling, discoloration, deformity | *Typically occurs during intercourse with receptive partner on top | ||
*Cracking sound followed by pain, usually immediate detumescence, swelling, discoloration, deformity | |||
[[File:Penile Fracture.jpg|thumb]] | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Template:Penile Trauma DDX}} | {{Template:Penile Trauma DDX}} | ||
== | ==Evaluation== | ||
*Retrograde urethrogram may be necessary to assure urethral integrity | *Clinical diagnosis | ||
*Rule out other trauma | |||
*Do NOT pass foley until confirming patient can pass urine OR | |||
*Retrograde urethrogram may be necessary to assure urethral integrity (especially important if pt unable to urinate) | |||
*Urology may request corpus cavernosography, MRI, or ultrasound if the penile fracture is atypical<ref>Lee S. et al. Trauma to male genital organs: a 10-year review of 156 patients, including 118 treated by surgery. BJU Int. 2008 Jan;101(2):211-5</ref> | *Urology may request corpus cavernosography, MRI, or ultrasound if the penile fracture is atypical<ref>Lee S. et al. Trauma to male genital organs: a 10-year review of 156 patients, including 118 treated by surgery. BJU Int. 2008 Jan;101(2):211-5</ref> | ||
==Management== | ==Management== | ||
*Surgical exploration required for most injuries if there is obvious or suspected fracture | *Surgical exploration/repair required for most injuries if there is obvious or suspected fracture | ||
*Penile hematoma with no fracture can be treated as an outpatient with NSAIDs | |||
*Penile | *Penile laceration with no fracture can be closed with 4-0 or 5-0 absorbable sutures | ||
* | |||
==Disposition== | ==Disposition== | ||
*Admit | *Admit, usually to OR for operative repair | ||
==See Also== | ==See Also== | ||
*[[Penile | *[[Penile trauma]] | ||
==References== | ==References== | ||
Latest revision as of 18:22, 29 March 2023
Background
- Tunica albuginea of one or both corpora cavernosa ruptures due to trauma to erect penis
- Can be associated with urethral rupture and deep dorsal vein injury
- Unlikely to occur in blunt pelvic trauma with a flaccid penis
- Associated with a urethral injury in up to 38% of penile fractures[1]
Clinical Features
- Penis is circumstantially swollen, discolored, tender, and flaccid
- Typically occurs during intercourse with receptive partner on top
- Cracking sound followed by pain, usually immediate detumescence, swelling, discoloration, deformity
Differential Diagnosis
Penile trauma types
Evaluation
- Clinical diagnosis
- Rule out other trauma
- Do NOT pass foley until confirming patient can pass urine OR
- Retrograde urethrogram may be necessary to assure urethral integrity (especially important if pt unable to urinate)
- Urology may request corpus cavernosography, MRI, or ultrasound if the penile fracture is atypical[2]
Management
- Surgical exploration/repair required for most injuries if there is obvious or suspected fracture
- Penile hematoma with no fracture can be treated as an outpatient with NSAIDs
- Penile laceration with no fracture can be closed with 4-0 or 5-0 absorbable sutures
Disposition
- Admit, usually to OR for operative repair