Treatment of urethral trauma in penile fracture

Abstract

BACKGROUND: Penile fracture is a rare injury that most often occurs during intercourse. In 238 % of cases, a penile fracture is accompanied by an injury to the urethra.
 AIM: To determine rational treatment of patients with urethral injuries of varying severity as a result of a penile fracture.
 MATERIALS AND METHODS: The retrospective group of the study included 8 patients in whom a penile fracture was accompanied by an injury to the urethra. Among them, in 6 (75%) patients, along with a rupture of the albuginea and urethra, unilateral damage of cavernous body was observed. The severity of trauma to the penis and urethra was assessed according to the classification of the American Association for the Surgery of Trauma (AAST).
 RESULTS: According to the diagnostic results, the fracture of the penis in all patients corresponded to the grade III according to the AAST classification. Urethral injury in 7 patients was grade III, and one was grade I according to the AAST classification. Patients with grade III urethral injury underwent primary urethral plastic surgery. A patient with grade I was treated conservatively. In all patients the bladder was drained with a urethral catheter. Penile fracture was treated surgically in all cases.
 CONCLUSIONS: A penile fracture associated with urethral trauma always requires immediate surgical treatment. In case of injuries of the urethra III grade according to AAST, the urethral catheter installation and conservative management are indicated. In case of injury of the urethra III, IV, V grade according to AAST, urgent primary urethroplasty is necessary. Damage to the corpora cavernosa and albuginea require surgical treatment after restoration of the integrity of the urethra.