It is a rupture of the tunica albuginea of the penis as a result of forceful bending of the erect penis, most commonly during sexual intercourse. Most patients report a cracking or snapping sound followed by immediate detumescence. The pain raises sharply.
Clinical appearance
Patients usually present penile swelling and ecchymosis after penile fracture. Other symptoms may include penile pain and penile angulation. Blood at the urethral meatus, gross hematuria or inability to void should be interpreted as a possible concomitant urethral injury.
Diagnosis
Physical examination and anamnestic report should guide the diagnosis of penile fracture. In patients with equivocal signs, ultrasound and/or magnetic resonance should be performed to identify small raptures of the tunica albuginea.
Observation
In patients with equivocal signs, where ultrasound and/or magnetic resonance do not identify signs of fracture, watchful waiting should be preferred. Patient is usually hospitalized and observed for 24-48 hours. Additional investigations can be uroflow and urethrography to exclude an urethral involvement. Repeating ultrasound scan is also advised. Penile color doppler with papaverine-induced erection is recommended after some weeks (4-6 weeks) to exclude vascular or neurogenetic damages, erectile dysfunction, or penile curvature.
Surgical repair
The repair is performed within the first 24-48 hours from trauma to improve long-term patient outcomes. Patient undergoes general anesthesia. The two injured corpora cavernosa are exposed through either a ventral midline or circumcision incision. Tunical repair is performed with absorbable suture (polydioxanone suture). Urethral repair is also performed if necessary. Compressive bandage is placed at the end of surgery and kept for 48 hours. Catheter is also placed for 24 hours. In case of urethral repair the catheter is kept for more days. Sexual intercourse should not take place for at least 2 months from the operation.
