Thanks to Dr. Waldman for today’s Morning Report!
Penile Fractures
Definition: But there’s no bone… traumatic rupture of the corpus cavernosum
Mechanism:
- Sudden blunt trauma or abrupt lateral bending of the penis in an erect state
- Breaks the markedly thinned and stiff tunica albuginea (during an erection the tunica albuginea thins from 2 mm to 0.25-0.5 mm, stiffens, and loses elasticity)
- One or both corpora may be involved, and concomitant injury to the penile urethra may occur.
- 1/3 cases during sexual relations, common in female dominant positions
- In Middle Eastern countries, the injury is usually due to penile manipulation to achieve detumescence
Diagnosis:
- History: typically a crack or popping sound, followed by immediate detumescence
- Exam:
- Penis is often deviated away from the site of the tear secondary to mass effect of the hematoma
- If the Buck fascia is intact, penile ecchymosis is confined to the penile shaft.
- If the Buck fascia has been violated, the swelling and ecchymosis are contained within the Colles fascia. In this instance, a “butterfly-pattern” ecchymosis may be observed over the perineum, scrotum, and lower abdominal wall.
- “Rolling sign”- palpation of the localized blood clot over the site of rupture. The clot may be felt as a discreet firm mass over which the penile skin may be rolled.
- Rupture of the deep dorsal vein- similar presentation, no popping sound, no immediate detumescence of the penis, “eggplant” sign
- Diagnostic cavernosography or MRI
- RUG pre-operatively
Treatment: GU emergency!
The goals of treatment for penile trauma are universal
- preservation of penile length
- erectile function
- maintenance of the ability to void while standing
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
The following two tabs change content below.
Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
Latest posts by Jay Khadpe MD (see all)
- Morning Report: 7/30/2015 - July 30, 2015
- Morning Report: 7/28/2015 - July 28, 2015
- IN THE STRETCHER INSTEAD OF BESIDE IT - July 22, 2015
- Morning Report: 7/14/2015 - July 14, 2015
- Morning Report: 7/10/2015 - July 10, 2015