Penile fracture is a rare event, however requires emergency diagnosis and intervention.
It is a rupture of corpora cavernosa and penile sheath (tunica albuginea) caused by trauma to an erect penis, most commonly during sexual intercourse. What a urologist needs to known in such an emergency, is to know whether tunica albuginea is ruptured and if its extent is up to the urethra. This will help to determine if an emergent surgical exploration is indicated, and what structures need to be repaired.
Patients typically have a characteristic history of trauma in an erect penis: a 'crack' may be heard with associated severe pain, loss of erection and a suddenly swollen penis.
During erection, there is thinning of tunica albuginea, and thus it is susceptible to injury. Corpora cavernosa is injured as soon as tunica albuginea is breached. However, urethral injury is associated only with a very severe injury.
Fractures usually occurs in distal two-thirds of the penis 1.
An emergency ultrasound is usually the first step, but because the penis is so swollen and painful, it is often not worthwhile. MRI of the penis is the most useful study, to determine the extent of lesion. Another study, which may be useful, is retrograde urethrogram, but this is also done as post-operative follow-up, rather than emergency setting.
Tunica albuginea is usually seen as a hyperechoic linear band in the penis covering two corpora cavernosa and the corpora spongiosa. A hypoechoic breach in this band may be seen especially along the longitudinal axis of penis. Associated collection is also seen along the breach.
Tunica albuginea is a hypointense band on all sequences. A tear can be seen as T2 hyperintense breach in this band. MRI can accurately determine if the fracture is transversely or longitudinally oriented. Also, it can accurately depict depth and extent of tear.
It is an interventional procedure and usually avoided, however, may depict the tear in corpora cavernosa.
Urethral rupture or post-traumatic stricture can be depicted by this imaging.
Treatment and prognosis
If there is no tunica albuginea rupture, conservative management can be done.
However, in cases of tunica albuginea rupture, it is better to explore surgically and repair the tunica, to reduce the chances of fibrous plaque formation or angulated penis1.
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- 2. Bhatt S, Kocakoc E, Rubens DJ et-al. Sonographic evaluation of penile trauma. J Ultrasound Med. 2006;24 (7): 993-1000. Pubmed citation
- 3. Uder M, Gohl D, Takahashi M et-al. MRI of penile fracture: diagnosis and therapeutic follow-up. Eur Radiol. 2002;12 (1): 113-20. doi:10.1007/s003300101051 - Pubmed citation
- 4. Abolyosr A, Moneim AE, Abdelatif AM et-al. The management of penile fracture based on clinical and magnetic resonance imaging findings. BJU Int. 2005;96 (3): 373-7. doi:10.1111/j.1464-410X.2005.05634.x - Pubmed citation