Acute penile trauma: imaging features in the emergency setting

Cozzi, Diletta; Verrone, Giovanni Battista; Agostini, S.; Bartolini, Marco; D’Amico, Giuseppe; Pradella, Silvia; Miele, Vittorio

doi:10.1007/s11547-019-01065-1

Cited by 15 publications

(21 citation statements)

References 49 publications

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“…At the same time, Sokolakis et al (11) on 43 patients showed a MRI sensitivity, specificity, NPV and PPV equal 100, 77.8, 100 and 90.5%, respectively. Therefore, today, the use of MRI combined with dedicated protocols is strongly recommended in the clinical evaluation of penile injury (6)(7)(8) to plan the best therapeutic treatment for each patient (12)(13)(14)(15)(16)(17)(18). Despite the high accuracy, MRI is not always used in the evaluation of penile trauma because expensive and little available in emergency.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of penile injury: ten years experience of an emergency department

Panella

Pepe

Pennisi

2020

Arch Ital Urol Androl

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Introduction: To evaluate the imaging accuracy in the diagnosis and clinical management of penile injury.Materials and methods: From January 2010 to January 2020, 20 men (median age 40.2 years) were admitted to our Emergency Department with the diagnosis of penile injury; the penile trauma was related to sexual intercourse in 16 cases, masturbation in 3 cases and injury caused by the partner in 1 case. All the patients underwent accurate medical history, clinical examinations and diagnostic imaging. Color Doppler ultrasound (CDU) evaluation was performed by Logiq E9 ecograph (General Electric; Milwaukee, WI) supplied with a linear probe small (7.5-10 MHz); magnetic resonance image (MRI) examination was performed within 3-24 hours from the trauma using a 1.5 Tesla scanner, (ACHIEVA 3T; Philips Healthcare Best, the Netherlands) performing pre-contrast and post-contrast multi-planar turbo spin-echo T1 and T2-weighted sequences. Results: 15/20 (75%) men with high suspicion of the tunica albuginea rupture underwent surgical exploration; conversely, 5/20 (25%) patients underwent conservative management. CDU detected 11/15 (73%) fractures of the penis and in 8 of them the length of the rupture was underestimated (more than 5 millimeters). On the contrary, MRI diagnosed all the albuginea ruptures showed by surgical exploration, but underestimated the length of the lesions in 9/15 (60%) cases. The IIEF-5 score administered six months later penile trauma demonstrated a good performance in all the patients. Conclusions: In our series, all the patients with a tunica albuginea rupture < 5 mm. diagnosed by MRI were submitted to conservative management with a complete functional restitutio ad integrum.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of penile injury: ten years experience of an emergency department

Panella

Pepe

Pennisi

2020

Arch Ital Urol Androl

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“…If there is good visualization of critical structures by US, many decisive diagnoses of course can be made. For instance, intracavernous hematoma has a typical US appearance, as outlined by Cozzi et al Initially, these hematomas are hyperechoic and reshape as cystic formations over time (18). Hematoma can be treated conservatively as long as no rupture of the tunica albuginea is present (18).…”

Section: Patients Included In Statistcal Analysis (N=88)mentioning

confidence: 99%

Diagnostic performance of MRI and US in suspicion of penile fracture

Spiesecke¹,

Mang²,

Fischer³

et al. 2022

Transl Androl Urol

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Background: Penile fracture (PF) is defined as rupture of the tunica albuginea of the corpora cavernosa.While most authors agree that rapid surgical therapy of this rare pathology leads to the best patient outcome, the role of imaging is highly controversial in the published literature. To obtain further evidence concerning the diagnostic accuracies of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnostic assessment of patients with suspected PF. Methods: We systematically reviewed MRI and US examinations performed in our institution between 2000 and 2021 and correlated imaging reports with either intraoperative finding or final clinical diagnosis. Inclusion criteria were: (I) patient age ≥18 years, (II) examination between 2000 and 2021, (III) information available on patient's history and clinical presentation, and (IV) documented final diagnosis in discharge letter. Next to diagnostic accuracy, we describe typical imaging findings such as penile hematoma, tear of the tunica albuginea including location in terms of side and shaft segment affected, and involvement of corpus spongiosum.Results: Overall, 46 of 88 included patients (54.5%) had a confirmed diagnosis of PF. A total of 69 MRI and 31 US examinations were included. Sensitivity and specificity were 91.9% (95% CI: 78.7-97.2%) and 90.6% (95% CI: 75.8-96.8%) for MRI and 71.4% (95% CI: 45.4-88.3%) and 100.0% (95% CI: 81.6-100.0%) for US, respectively. Conclusions:The results of the present study suggest that MRI is more suitable to confirm PF and identify the site of the associated tunica albuginea tear while US is a good tool for ruling out PF.

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“…Penile traumas could be divided into blunt and penetrating. The latter are uncommon, and US has limited indications [2]. Blunt penile traumas result in different injuries depending on whether the penis is flaccid or erect [7,10,11].…”

Section: Traumatic Injuriesmentioning

confidence: 99%

“…Imaging is required in these patients to assess whether the tunica albuginea is intact or not, since albugineal disruption requires surgical repair, while other injuries can be managed conservatively. US is the first-choice imaging modality [2]. In penile fracture, patients typically report that they have heard a "cracking" or "popping" sound, associated with pain and followed by rapid detumescence, swelling, and deformity of the penis.…”

Section: Traumatic Injuriesmentioning

confidence: 99%

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Penile Ultrasound: An Essential Tool in an Emergency Setting (Traumatic and Non-Traumatic Diseases)

et al. 2022

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Penile conditions requiring urgent care are uncommon and result from trauma and a variety of non-traumatic causes. Some cases could rapidly evolve into an emergency situation and require prompt treatment to prevent severe complications. Therefore, correct and rapid diagnosis is fundamental. Although clinical history and physical examination are essential, diagnostic imaging is usually required to confirm the clinical diagnosis. In this setting, the sonologist in the emergency department has to be familiar with the basic US penile anatomy and with the most common US findings in urgent penile care. US is the key imaging method because it is readily available, safe, cost-effective, and well-tolerated by the patient. US can differentiate intracavernosal from extracavernosal hematomas and detect rupture of the tunica albuginea, consistent with penile fracture, that requires early surgical exploration. Color Doppler evaluation and spectral analysis are necessary to depict vascular abnormalities.

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Acute penile trauma: imaging features in the emergency setting

Cited by 15 publications

References 49 publications

Diagnosis and treatment of penile injury: ten years experience of an emergency department

Diagnosis and treatment of penile injury: ten years experience of an emergency department

Diagnostic performance of MRI and US in suspicion of penile fracture

Penile Ultrasound: An Essential Tool in an Emergency Setting (Traumatic and Non-Traumatic Diseases)

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