Surgical our experience in patients with penile fracture – part 1

Surgical our experience in patients with penile fracture – part 1

Abstract

Objective : We aimed to investigate the clinical features, diagnostic methods and surgical methods and results of patients who presented with penile fractures.

Materials and Methods : The data of 18 patients who underwent surgical treatment between December 2008-2018 in our clinic were evaluated retrospectively. Age and etiologic factors were evaluated. Following physical examination, all patients underwent superficial penile ultrasonography in the radiology clinic. Ultrasonically, length, location and side of the rupture were determined. The patients were questioned by the postoperative IIEF-5 questionnaire. Pre and post-operative complications were evaluated in patients. Postoperative erectile functions were evaluated.

Results : The mean age was 39.22 ± 14.47 (19-67). The time to contact the emergency department was 4.33 ± 1.97 hours (2-8 hours). In the history of the patients, penile fracture occurred due to the forceful manipulation of the penis in 5 patients (27.8%), during turning in the bed during sleep in 5 patients (27.8%) , during sexual intercourse in 6 patients (33.3%) and during masturbation in 2 patients (11.1%). Mean tear size in tunica albuginea was 12.66 ± 3.06 mm (8-20mm). While 11 (61.1%) of the defects were detected in the right corpus spongiosum, 7 (38.9%) were detected in the left corpus spongiosum.   The tunica albuginea defect was located in the distal penile in 14 patients (77,8%), in the midpenil in 3 patients (16,7%) and in the proximal penile in 1 patient (5,5%). The mean hospital stay was 3 ± 0.90 days (2-5 days). Postoperative the IIEF-5 score was 26.05 ± 1.55 (23-29). After the fracture of the penis and complete healing, it is necessary to support the therapy with medical drugs. The most effective in the treatment of potency is Viagra. But it is very important to choose the optimal dosage of Viagra, but the most common – Viagra 100mg.

Conlcusion : Penile fracture is a rare urologic emergency that can be diagnosed clinically. Radiological imaging may be required in suspected cases. Early surgical treatment provides successful results in terms of functional, cosmetic and erectile functions.

Keywords: Penis,  fracture,  radiological evaluation, surgical treatment

INTRODUCTION

Penile fracture occurs as a result of blunt trauma of the penis in the erect state and rupture of the corpus cavernosum and / or spongiosum as a result of bending. The corpus cavernosum is responsible for erection and the tissue surrounding this structure is called tunica albuginea. The blood in the corpus cavernosum accumulates under the Buck fascia as a result of rupture of the tunica albugine (1). If Buck’s fascia is also ruptured, bleeding and hematoma can lead to a butterfly-like appearance through the Colles fascia, spreading towards the scrotal region and perineum (2). If it is accompanied by  urethral injury, urethrorage may also be seen. In the etiology, sexual intercourse is observed the most commonly, while masturbation or sudden position changes during night erection are observed less frequently (3). Other than these etiological causes, hitting somewhere during an erection, and wearing pants are other reported reasons (4,5). While the thickness of the tunica albuginea is normally 2 mm, this thickness decreases to 0.25 mm in erection and intracorporeal pressure increases as a result of trauma and penile fracture occurs (6-9). While the rupture is mostly unilateral, the severity of trauma increases and bilateral or even urethral injury can be seen (10).

Typical findings start with patients experiencing a sudden breaking sound and may be accompanied by severe pain. Erection disappears quickly, swelling and ecchymosis occur due to hematoma on the side of the fracture and penis deviation is seen towards the opposite side of the fracture (5). While physical examination and anamnesis is usually sufficient for diagnosis, sometimes urethrography can be used in the diagnosis of superficial penile ultrasound, penile doopler ultrasonography, magnetic resonance imaging (MRI), cavernosography and cases describing urethrorrhagia (11). Penile fracture is treated by a surgical repair of tunica albuginea in the early stage (12).

In this study, we aimed to investigate the clinical features, diagnostic methods and surgical methods and results of patients who presented with penile fractures.

MATERIALS AND METHODS

The data of 18 patients who underwent surgical treatment between December 2008 and December 2018 in our clinic were evaluated retrospectively. The local ethical committee approval was obtained to conduct the study. Detailed anamnesis was obtained from the patients, the majority of whom were admitted to the emergency department . Age and etiologic factors of the patients were evaluated. Following physical examination, all patients underwent superficial penile ultrasonography in the radiology clinic. Ultrasonically, length, location and side of the rupture were determined.  No additional radiological examination was required as no patient had urethrorage. The patients were informed about the risks by giving surgical information before the surgery. The patients were administered broad-spectrum antibiotherapy before the surgery and a foley catheter was inserted. In all cases, subcoronal circumferential incision was made and penis skin was deglove. After the subcutaneous tissue and the factional passage, the hematoma was evacuated and the rupture of the tunica albugia was detected. Then the ruptures were sutured using vicryl. After skin suture, tight bandage was applied with Koban. On the 1st postoperative day, the folley was applied to all patients. The duration of hospital stay was recorded. Patients were advised not to have sexual intercourse and masturbation for 6 weeks while they were discharged. The patients were then called to the outpatient clinic and physical examinations were performed. The IIEF-5 form was filled out and they were asked whether there was curvature of the penis during erection and their answers were recorded.

STATISTICAL ANALYSIS

In our study, data were calculated as mean ± standard deviation, median and interquartile range. Statistical analyses were made with SPSS18.0 (SPSS Inc., Chicago, IL, USA) and MED CALC 11.0 (Ostend, Belgium) statistical programs – read more – part 2.


By Dr. Ravi Mootha, M.D. On: May 07, 2019 at 19:59:19