PENILE FRACTURE

Lakshay Chanana
Clinical Fellow, Emergency Medicine
LNWH NHS Trust
- @EMDidactic
 OUTLINE
Story
Relevant Anatomy
Mechanism
Diagnosis and Imaging
Management and Complications
Evidence
 Story

Young Male presented to the ED

BIBA with penile pain and swelling
Accompanied by his partner
Fall from Bed Heard a popping sound
Obs Stable, Pain ++
 Examination

Swelling
Tenderness
Hematoma
Bluish Black discoloration

Must look for blood in meatus

 Penile Fracture
Traumatic rupture of the tunica albuginea
of the corpora cavernosum

Happens only during erection as TA thins

from 2 mm to 0.5 - 0.25 mm (Pressures
>1500mm Hg)

Blunt trauma in flaccid state is not

considered as a fracture
Jack GS, Garraway I, Reznichek R, Rajfer J: Current treatment options for penile frac- tures. Rev Urol
2004;6:114120.
 MECHANISM

Sexual intercourse
Masturbation
Rolling over on the bed
Falling onto the erect penis
DIAGNOSIS
 Classic History
Audible popping sound (85%), followed by
pain (50%)
Rapid detumescence (95%),
Swelling and discoloration (90%).

Uretheral Injury More common when both

CC are injured
 IMAGING
Often not needed but options include

USG
Cavernosography (time, expertise, and equipment
required, allergic reaction, corporal fibrosis, and
priapism)

Retrograde Urtethrogram (r/o uretehral injury)

MRI (very accurate but ?time, cost, availability)
 MANAGEMENT
Non-Operative 30% complication rate.
Ice packs, Foley catheterization, and anti-
inflammatory medicines, erection-inhibiting
estrogens, penis splints, antibiotics, and
fibrinolytic agents

Operative 4% complication rate,

Hematoma evacuation and repair of the
defect
 COMPLICATIONS
Uretheral Injury
Urethral stricture and urethral cutaneous
fistulae
Painful erections
Severe penile angulation
Arterial-venous fistulas, infected
hematomas, abscess formation, and
impotence/ED
 EVIDENCE
Surgical Repair >>> Conservative

Delayed presentation (after days)

Surgical Repair is still highly
recommended

Good outcomes in 92% of patients treated

surgically versus only 59% in those treated
conservatively.
 Take Home (Penile Fracture)
Rupture of Tunica Albuginea of CC
Mechanism Often Vigorous Intercourse
Diagnosis Clinical
Image equivocal cases to r/o uretheral injury

Rx Pain Relief, Early Surgical Repair (<8hrs)

to prevent complications