Penile Fracture: Diagnosis, Treatment and Outcomes of 150 Patients

Koifman, Leandro; Barros, Rodrigo; Júnior, Ricardo A.S.; Cavalcanti, André G.; Favorito, Luciano A.

doi:10.1016/j.urology.2010.05.043

Cited by 110 publications

(99 citation statements)

References 21 publications

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“…Most recent studies favor early surgical repair because of the adequate functional and cosmetic results with minimal complications. [2][3][4][5][6][7][8][9][10] Late complications of penile fracture comprise ED, deviation of the erect penis, development of plaques resembling those of La Peyronie disease, urethrocavernous or urethrocutaneous fistula and poor urinary stream. [9][10][11][12] ED is a critical problem that may have serious physical and psychological consequences.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture

et al. 2011

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This study was conducted to determine the preoperative and intraoperative risk factors of ED and the underlying penile vascular abnormalities among patients with penile fracture treated surgically. In all, 180 patients with penile fracture were treated surgically and followed up in one center. None of our patients had ED before the penile trauma and only two of them had risk factors for systemic vascular diseases, such as diabetes mellitus (one patient) and hypertension (one patient). After a mean follow-up of 106 months, 11 patients (6.6%) developed ED, 7 had mild ED and 4 had moderate ED. The main risk factors for subsequent ED were aging, 450 years, and bilateral corporal involvement. Among the 11 patients with ED, color Doppler ultrasonography (CDU) showed normal Doppler indices in 4 (36.4%), veno-occlusive dysfunction in 4 (36.4%) and arterial insufficiency in the remaining 3 (27.2%) patients. CDU assessments from the injured and intact sides were comparable. ED of either a psychological or vascular origin can be encountered as a long-term sequel of surgical treatment of penile fracture. Aging, 450 years, at presentation and bilateral corporal involvement is the main risk factors for subsequent development of ED.

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Section: Introductionmentioning

confidence: 99%

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture

et al. 2011

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“…Longitudinal tears are rare; none of our patients with acute penile fractures had longitudinal tears. The diagnosis of penile fracture is usually established based on its characteristic history and physical findings [13]. Patients report hearing a snapping sound during the sexual act, followed by immediate pain and penile detumescence, in addition to the emergence of large edemas, hematomas, and penile deformity [14].…”

Section: Discussionmentioning

confidence: 99%

The role of ultrasonography in the diagnosis and management of penile trauma

Dell’Atti¹

2016

J Ultrasound

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Purpose In this prospective study, we studied the role of ultrasonography (US) in the diagnosis and management of penile trauma. Methods Between 2007 and 2014, 14 patients (mean age 39 years) with suspected penile fracture underwent US examinations. Almost all patients had a history of injury during sexual intercourse or manipulation of the penis. US examinations were performed in transversal and longitudinal planes starting at the level of the glans and moving down to the base of the penis. Color-Doppler was used to identify the vascular pattern or to see any abnormal vascularity. Results The most common blunt injury to the penis that occurred in nine patients was penile fracture due to rupture of the corpus cavernosum. A tear occurred in only one of the corpora cavernosa. US showed an irregular hypoechoic or hyperechoic defect at the cavernosal rupture site. Four patients presented an injury to the subtunical venous plexus in the absence of complete tunical disruption. One patient had urethral rupture with inability to urinate and apparent urethrorrhagia. Ten patients underwent surgical operation, while four patients were observed and discharged after 2 days. Mean follow-up was 32 months (range 3-58). After 8 to 12 weeks, all of them were able to be sexually active as before. Angulations of penis persisted in one patient. Conclusion US may be the preferred imaging technique for evaluation of penile fracture before surgery. It is easy to perform, non-invasive, widely available, and inexpensive, although it requires an experienced team.Keywords Penile trauma Á Penile fracture Á Ultrasonography Á Color-Doppler sonography Á Imaging Á Tunica albuginea Riassunto Scopo In questo studio prospettico abbiamo analizzato il ruolo dell'imaging ecografico nella diagnosi e gestione del trauma penieno. Metodi Tra il 2007 ed il 2014, 14 pazienti (età media: 39 anni) con sospetto di frattura del pene furono sottoposti ad uno studio ecografico. Quasi tutti i pazienti presentavano un riscontro anamnestico di traumi avvenuti durante un rapporto sessuale o manipolazione del pene. Gli esami ecografici furono eseguiti facendo scansioni su piani trasversali e longitudinali iniziando a livello del glande e procedendo sino alla base dell'asta. L'utilizzo del ColorDoppler è stato adoperato per visualizzare l'assetto vascolare o per identificare qualsiasi forma di anomalia vascolare. Risultati La più comune forma di rottura traumatica del pene accorsa in 9 persone fu quella del corpo cavernoso. la rottura si verificò sempre a livello di un singolo corpo cavernoso. Lo studio ultrasonografico identificò il punto di rottura a livello del corpo cavernoso attraverso la visualizzazione di un irregolare stria ipoecogena o iperecogena. 4 pazienti presentarono una lesione del plesso venoso al di sotto della tunica albuginea senza rottura della stessa. Un solo paziente riportò un trauma dell'uretra presentando difficoltà alla minzione ed uretrorragia. 10 pazienti furono sottoposti ad intervento chirurgico, mentre gli altri 4 furono ricovera...

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“…5,6,18 Sexual dysfunction observed after treatment is of interest in patients with penile fracture. For example, in Zargooshi's study, 98.6% of patients who underwent surgical repair were reported to be potent postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 The best initial management of penile fracture is usually immediate surgical repair. [4][5][6] Immediate surgical intervention with evacuation of hematoma and repair of the ruptured tunica albuginea shows good functional results with low morbidity and short hospital stay. In earlier studies, a conservative regimen such as ice pack compresses followed by hot packs, foley catheterization or suprapubic urinary diversion, compression bandages, erectioninhibiting estrogens, antibiotics, and anti-inflammatory medicines were recommended.…”

Section: Introductionmentioning

confidence: 99%

No evidence of depression, anxiety, and sexual dysfunction following penile fracture

et al. 2011

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There is a gap in the literature about psychological status of patients following penile fracture surgery. We aimed to assess the long-term psychological status of penile fracture patients who have been treated by immediate surgical repair. A total of 32 patients with penile fracture have been treated surgically at our center. These 32 patients and 30 healthy control subjects were included in the study. All participants have completed the Hospital Anxiety and Depression Scale (HADS), Glombok-Rust Inventory of Satisfaction Scale (GRISS), and the premature ejaculation diagnostic tool (PEDT). The mean age of patients was 30.4 years and the mean body mass index was 27.3 kg m À2 . Sexual intercourse was the most common cause of the fracture. Immediate surgical repair was performed in all cases using a circumferential subcoronal incision and none of the patients had urethral injury intraoperatively. All tears were unilateral with a mean size of 1.5 cm. Only two patients had superficial dorsal vein rupture. At the day of assessment, the mean time elapsed after penile trauma was 15.9±6.3 months (range: 6-23). Only three patients had complications due to penile fracture including minimal penile curvature, penile nodule, and penile pain during intercourse. The mean scores obtained from PEDT, HADS, and GRISS did not show any statistically significant difference between groups. Anxiety, depression, premature ejaculation, and sexual dyssatisfaction levels were similar in both penile fracture patients who underwent immediate surgical repair and healthy control subjects. Immediate surgical repair of corporal ruptures have not shown any harmful psychogenic sequelae on patients with penile fracture.

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Penile Fracture: Diagnosis, Treatment and Outcomes of 150 Patients

Cited by 110 publications

References 21 publications

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture

Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture

The role of ultrasonography in the diagnosis and management of penile trauma

No evidence of depression, anxiety, and sexual dysfunction following penile fracture

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