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

Abstract

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.

WITHDRAWN: Penile Injury: 4 Years’ Experience of A single Surgeon in A limited Resources Setting

“…Penile fracture is one of the most frequent presentations of penile injury, that is rstly described in 1925 (7). It is a rupture of tunica albuginea of the corpus cavernosum (16), commonly during sexual intercourse and rarely due to forceful bending of the erected penis (maneuver of Taghaandan) (17). 15 to 37% of cases are associated with penile urethral injury (18).…”

“…Retrograde urethrography is spared for cases of associated urethral injury (7). Early surgical treatment is recommended (17) to minimize the rate of complications that may include erectile dysfunction, penile curvature, deformity, and painful erection (16). Tension-free primary repair of penile urethral injury is the accepted treatment in the setting of associated urethral injury (18).…”

Case Report: An extremely rare penile shrapnel injury

“…The significance of this case is that an isolated piece of shrapnel had lodged in the soldier's penis, causing the distal corpus cavernosum to rupture. Literature recommend early surgical exploration of penis can alleviate pain and reduce the risk of erectile dysfunction, corpora cavernosa fibrosis, and penile symptomatic scarring or recurrence ( 14 ). Through our timely surgery to remove the shrapnel completely, the patient had a normal penile erection on the first postoperative day.…”

Bilateral penile crural fractures due to traumatic injuries: A rare case report and literature review

“…Injuries to the penile crus can often be overlooked because of its clinical similarities to urethral trauma. Therefore, imaging is necessary [ 2 ]. The optimal treatment for penile crural fractures remains controversial.…”