Dr. Subhash Goyal, Dr. Sankalp Dwivedi, Dr.Mohinder Kumar, Dr. Kunal Chowdhary
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Penile fracture remains a rare, yet likely underreported condition. Fracture of the penis is a tear in the tunica albuginea of the corpora cavernosa with or without injury to the corpus spongiosum and urethra. Diagnosis is usually clinical and urethral injury should be suspected in penile fracture, especially in those cases with bilateral cavernosal rupture. The usual cause is abrupt bending of the erect penis by blunt trauma most commonly during sexual intercourse. A crackling sound, pain, detumescence, bruising, swelling, and bleeding per urethra are the common symptoms reported by the patients. Early surgical management is the treatment of choice with low incidence of complications
We report a case of Fracture penis in a 35 year old male came to the emergency of our hospital.
History of pain, swelling, discoloration & detumescence of the penis. Patient gave history of sudden change of posture while asleep with erect penis leading to severe pain and onset of swelling about 6 hours back. Patient was able to pass urine without difficulty and was not complaining of blood over the urethral meatus.
Physical examination revealed a swollen, ecchymotic penis. Tenderness was present over the shaft of the penis more over the right side. Glans penis was not visible due to gross swelling of the prepuce. Penis was flaccid and deviated to the left side with discoloration of the penile shaft.
Swelling of prepuce with detumescene
On the basis of clinical examination diagnosis of Fracture penis without involvement of bulbar urethra was made and diagnosis was confirmed by M.R.I penis. M.R.I Penis showed a transverse tear in the tunica albuginea of the rt corpora cavernosa of about 4mm with Haematoma extending between skin and tunica over the penile shaft.
Patient was catheterized with foley 14 Fr and routine blood investigation were done. The patient underwent immediate surgical exploration and repair of the fracture. Circumferential subcoronal degloving incision (circumcision – like) and hematoma evacuation presented a partial tear of the tunica albuginea of right sided corpus cavernosum .4/0 prolene continuous sutures were used to repair rupture of rt. corpus cavernosus. Skin closed with prolene 4/0 suture.
Penile fracture is a rare urological emergency. Diagnosis is mainly clinical. Immediate surgical intervention is required to decrease the complications. A sub-coronal or circumferential is the best described surgical approach. Other approaches described include penoscrotal, inguinoscrotal, lateral and suprapubic incisions.
