Penile fracture

Background
  • Tunica albuginea of one or both corpus cavernosa ruptures due to trauma to erect penis
  • Can be associated with urethral rupture and deep dorsal vein injury
  • Unlikely to occur in blunt pelvic trauma with a flaccid penis
  • Associated with a urethral injury in up to 38% of penile fractures[1]

Clinical Features
  • Penis is circumstantially swollen, discolored, tender, and flaccid
  • Typically occurs during intercourse with receptive partner on top
  • Cracking sound followed by pain, usually immediate detumescence, swelling, discoloration, deformity

Differential Diagnosis

Penile trauma

Evaluation
  • Clinical diagnosis
  • Rule out other trauma
  • Do NOT pass foley until confirming patient can pass urine OR
  • Retrograde urethrogram may be necessary to assure urethral integrity (especially important if pt unable to urinate)
  • Urology may request corpus cavernosography, MRI, or ultrasound if the penile fracture is atypical[2]

Management
  • Surgical exploration/repair required for most injuries if there is obvious or suspected fracture
  • Penile hematoma with no fracture can be treated as an outpatient with NSAIDs
  • Penile laceration with no fracture can be closed with 4-0 or 5-0 absorbable sutures

Disposition
  • Admit, usually to OR for operative repair

See Also

References
  1. Wessells H et al. Penile and genital injuries. Urol Clin North Am. 2006 Feb;33(1):117-26
  2. Lee S. et al. Trauma to male genital organs: a 10-year review of 156 patients, including 118 treated by surgery. BJU Int. 2008 Jan;101(2):211-5
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