Penis Fracture – Diagnosis and Treatment

A penis fracture is a traumatic rupture of the tunica albuginea.

Penis fractures commonly occur during sexual intercourse with the patient’s partner on top of patient. The engorged corporal bodies in the patient’s erect penis can rupture with enough force against the pubic symphysis or perineum of his partner.

When this occurs, the patient will hear a pop, followed by detumescence and deformity of the shaft, as well as immediate swelling.

Of note, there is also a practice called “Taqaandan.” This is the most common cause of penile fracture in Middle Eastern countries. Taqaandan, which comes from a Kurdish word meaning “to click,” involves bending the top part of the erect penis while holding the lower part of the shaft in place, until a click is heard and felt. Taqaandan is said to be painless and has been compared to cracking one’s knuckles. Taqaandan may be performed to achieve detumescence and can become habitual. 

A classic “eggplant” appearance (swelling, discoloration, and deviation away from the defect in the tunica) of the penis is often seen.

The “butterfly sign” occurs when Buck’s fascia is disrupted resulting in swelling and ecchymosis throughout the perineum.

History and physical exam are usually enough to diagnose a penis fracture; however, it is important to identify urethral injury for our urology colleagues. On exam, patients with urethral injury will typically have blood at the meatus or gross hematuria.

Aside from surgical exploration, the gold standard to test for urethral injury is a retrograde urethrogram (“RUG”). A RUG involves placing a Foley into the patient’s urethra, injecting contrast dye, and then obtaining an image under fluoroscopy. There will be extravasation of dye at the site of urethral injury.

Ultrasound can also be used to visualize any breaks in the tunica albuginea. The tunica albuginea is a hyperechoic linear structure, which will have hypoechoic breaks in patients with penis fracture. You can also visualize flow across these hypoechoic breaks as well.

Urological consultation is a priority. Surgical exploration and repair is necessary to prevent long term sequelae of penis fracture. Complications may include penile deviation, painful intercourse, painful erection, erectile dysfunction, priapism, skin necrosis, arteriovenous fistula, urethrocavernous fistula, and urethral stricture. The goals of surgery are to evacuate the hematoma and repair any tunica albuginea/urethral defects.