Management of penile fractures complicated by urethral rupture

Abstract

The combination of lesions of the penile urethra and the corpus cavernosum is rare and likely to go unremarked. It worsens the immediate and long-term prognosis and poses a problem of management. Among 312 cases of penile fracture, we performed a retrospective study of a series of 10-case of traumatic corpora cavernosa rupture complicated with urethral rupture, treated in the department of Urology at 'Charles Nicolle' Hospital in Tunis. The median patients' age was 30 years. The most common mechanism was manipulation of an erect penis, found in six cases. Urethral rupture was suspected in all patients given the presence of bloody urethral discharge. No preoperative radiographic investigations were necessary. All patients underwent immediate surgical exploration. The urethral injury was always partial and localized at the level of the corpora tear. Surgical repair of both urethral and corpora tear was done in all patients. The follow up was uneventful. Urethrography at the removal of the transurethral catheter did not visualize contrast extravasation in any patient. No urethral stricture or erectile complaints were noted within a 36-month mean follow-up. Urethral rupture must be suspected in any case of penile fracture presenting with bloody urethral discharge. Standard treatment is immediate surgical repair.

Urethral pseudodiverticulum secondary to penile fracture and complete urethra dissection

“…6 Zaargoshi, however, showed an incidence of urethral lesion with corpora cavernosa fracture of 38% and the absence of these features did not exclude the possibility of urethral involvement. 9 Another study reported on 15 patients who underwent immediate surgical exploration; 4 of these had urethral injuries with no complications at 7.5 month follow-up.…”

“…Penile ultrasound can be used to assist the diagnosis of penile fracture; it can be easily performed, is non-invasive and useful in determining localized sub-Buck's fascia hematoma due to injury or to causes other than tunical tear. 6 Also magnetic resonance (MR) imaging is potentially useful to assess the penile rupture; the key finding is disruption of the low-signal intensity tunica albuginea, which is well-seen on both T1 and T2 weighted images, although T1 weighted sequences may detect more subtle fractures. 7 Treatment may be either conservative or immediate surgery.…”

Acute penile trauma and associated morbidity: 9-year experience at a tertiary care center

“…It is underreported, and the true incidence is unknown, although an extensive review by Eke in 2001 reported 1331 cases identified in literature from 1966 to 2001 (Redman & Miedema, 1981;Eke, 2002;Derouiche et al, 2008;Al-Shaiji et al, 2009). Injury is defined as traumatic rupture of the tunica albuginea of one or both of the corpora cavernosa, occurring most often in the young adult (Morey & Dugi, 2012).…”

“…Fracture can extend to involve the corpus spongiosum and urethra. Previously thought to be a rare complication of penile fracture, urethral injury has been associated with between 10 and 38% of all penile fractures in the United States and Europe (Cendron et al, 1990;Tsang & Demby, 1992;Gottenger & Wagner, 2000;Derouiche et al, 2008;Al-Shaiji et al, 2009). In the Middle East, urethral injury is far less common, occurring in 0-3% of fractures (Zargooshi, 2000).…”

“…This is likely due to the lower impact mechanism of injury of these fractures, with the majority (69%) occurring from manual deflection of the penis, and only 8% associated with sexual intercourse (Zargooshi, 2000). Involvement of the urethra may worsen the patient's overall prognosis and make management more complex (Derouiche et al, 2008). Reported complications of fracture include penile curvature and shortening, erectile dysfunction, and urethral stricture (Al-Shaiji et al, 2009;Morey & Dugi, 2012).…”