Thanks to Dr. Waldman for today’s Morning Report!
Penile Fractures
Definition: But there’s no bone… traumatic rupture of the corpus cavernosum
Mechanism:
- Sudden blunt trauma or abrupt lateral bending of the penis in an erect state
- Breaks the markedly thinned and stiff tunica albuginea (during an erection the tunica albuginea thins from 2 mm to 0.25-0.5 mm, stiffens, and loses elasticity)
- One or both corpora may be involved, and concomitant injury to the penile urethra may occur.
- 1/3 cases during sexual relations, common in female dominant positions
- In Middle Eastern countries, the injury is usually due to penile manipulation to achieve detumescence
Diagnosis:
- History: typically a crack or popping sound, followed by immediate detumescence
- Exam:
- Penis is often deviated away from the site of the tear secondary to mass effect of the hematoma
- If the Buck fascia is intact, penile ecchymosis is confined to the penile shaft.
- If the Buck fascia has been violated, the swelling and ecchymosis are contained within the Colles fascia. In this instance, a “butterfly-pattern” ecchymosis may be observed over the perineum, scrotum, and lower abdominal wall.
- “Rolling sign”- palpation of the localized blood clot over the site of rupture. The clot may be felt as a discreet firm mass over which the penile skin may be rolled.
- Rupture of the deep dorsal vein- similar presentation, no popping sound, no immediate detumescence of the penis, “eggplant” sign
- Diagnostic cavernosography or MRI
- RUG pre-operatively
Treatment: GU emergency!
The goals of treatment for penile trauma are universal
- preservation of penile length
- erectile function
- maintenance of the ability to void while standing
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Jay Khadpe MD
- Editor in Chief of "The Original Kings of County"
- Assistant Professor of Emergency Medicine
- Assistant Residency Director
- SUNY Downstate / Kings County Hospital
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