Wednesday, November 3, 2010

Penis Fracture:An andrological Emeregncy

A 25 year old gentleman married recently came to us with penile swelling after an episode of violent sexual activity.He presented with eggplant deformity of the penis with a large hematoma.

As a routine we performed retrograde urethrogram to see any urethral trauma.The urethral integrity was intact.He was immediately taken up for exploration;he underwent degloving incision of the penis and he underwent repair of the tunica with nonabsorbale sutures after evacuation of the hematoma.

He was discharged after 1 week and he regained his potency (as per the patient told on 8 week follow-up).

A penile fracture is an injury caused by the rupture of the tunica albuginea, which envelops the corpus cavernosum penis. It is most often caused by a blunt trauma to an erect penis.
A popping or cracking sound, significant pain, immediate flaccidity, and skin hematoma of various sizes are commonly associated with the event. These symptoms are similar to a common bruising or contusion of the penis. If Bucks fascia is intact then ecchmosis is confined to penis and the penis may appear like eggplant and if the Bucks fascia is disrupted then “butterfly” hematoma may occur over the region of the perineum. Causes
In the western world the most common cause, accounting for about 30%-50% of cases, is intercourse. Of those, woman-on-top position resulting in impact against the male pelvis or perineum and bending laterally are most common.
The practice of taqaandan also puts men at risk of penile fracture. Taqaandan, which comes from a Kurdish word meaning "to click," involves bending the top part of the erect penis while holding the lower part of the shaft in place, until a click is heard and felt. Taqaandan is said to be painless and has been compared to cracking one's knuckles, but the practice of taqaandan has led to an increase in the prevalence of penile fractures in western Iran. Taqaandan is usually performed to achieve detumescence.

Penile fracture can be diagnosed by history or physical signs (a careful examination may reveal “Rolling sign”-palpation of blood clot over a break on tunica albugenia).In equivocal cases cavernosography or MRI may have to be performed. If urethral bleeding is also a presentation then retrograde urethrogram should be done to diagnose the urethral trauma.

Treatment and prognosis
Penile fracture is a medical emergency, and emergency surgical repair is the usual treatment. Delay in seeking treatment increases the complication rate. Non-surgical approaches result in 10%-50% complication rates including erectile dysfunction, permanent penile curvature, damage to the urethra and pain during sexual intercourse.
A circumferential degloving incision is given 1 cm proximal to the coronal sulcus then the trauma site is identified and the hematoma is evacuated. The defect in the tunica albugenia is repaired with inverting non-absorbale sutures.

1 comment:

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