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      Isolated penile urethral injury: A rare case following male coital trauma

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          Abstract

          Penile fractures are an uncommon urological emergency. Typically, penile fractures involve the corpus cavernosum and are sometimes associated with urethral injury. Isolated corpus spongiosum and urethral injuries without concomitant corpus cavernosum injury are, however, rare. With proper knowledge of the management of penile fractures and urethral injuries, this distinct entity can be diagnosed, assessed and managed successfully without complications.

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          Most cited references29

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          Fracture of the penis.

          N Eke (2002)
          Sporadic reports of penile fracture give the impression of a rare trauma. The value of diagnostic investigations is doubtful and treatment options are controversial. A Medline search from January 1966 to July 2001 using the terms 'fracture of penis', 'penile trauma' and 'coital injuries' was used to identify full texts of publications on fracture of the penis. Full texts of relevant references from these publications were also identified. Data extracted for review included authors, country and year of publication, number of cases in each report, aetiology, clinical features, investigations, treatment and outcome. In 183 publications 1331 cases were reported between January 1935 and July 2001. Most reports were from the Mediterranean region. The commonest causes were coitus and penile manipulations, especially masturbation. Most patients were in their fourth decade. Clinical features included sudden penile pain, detumescence, voiding difficulties, and penile swelling and deviation. Diagnosis was made mainly on clinical grounds. Associated injuries included urethral rupture. Predisposing factors included excessive force at coitus or manipulation, fibrosclerosis of the tunica albuginea and chronic urethritis. Most authors advocated early surgical repair using absorbable sutures. Complications of the injury included coital difficulty, urethral fistula, penile plaque and erectile dysfunction. Penile fracture is not rare. Radiological investigations are expensive and may delay treatment. Current management favours early surgical exploration to prevent complications.
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            Penile fracture in Kermanshah, Iran: report of 172 cases.

            J Zargooshi (2000)
            Experience with 172 cases of penile fracture, in Kermanshah, Iran is reviewed. Records of penile fracture cases were reviewed from April 1990 to October 1999. Diagnosis was made clinically and there was no need to perform cavernosography in any case. The most common mechanism of fracture was referred to by patients as "taghaandan" (to click or snap when forcibly pushing the erect penis down to achieve detumescence). All but 2 cases were treated surgically and 2 cases had concomitant urethral injury diagnosed by selective urethrography. Repair consisted of a circumferential degloving incision to evaluate the corpora. Because of unavailability of synthetic absorbables, inverted knot nylon sutures were used successfully for repair. Delay in operation did not increase difficulty in dissection or early postoperative morbidity. Preoperative and postoperative use of antibiotics was effective in eliminating risk of infection. There were no significant intraoperative or immediate postoperative complications and most patients were discharged home on postoperative day 1. Patient misinformation about penile tissue properties is the main explanation for the high incidence of penile fracture. Cavernosography, and urethrography and intraoperative urethral catheterization are not routinely needed, as diagnosis can be made clinically. Preoperative and postoperative use of antibiotics, and a uniform surgical plan regardless of delay in presentation are recommended.
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              Long-term experience with surgical and conservative treatment of penile fracture.

              Michael Muentener, Stefan Suter, Dieter Hauri … (2004)
              Immediate surgical repair is widely accepted as the therapy of choice in penile fracture. As recent reports show, good results can also be achieved in some patients with conservative management. It is unclear which patients will truly benefit from an operation. We retrospectively compared the long-term outcomes of surgical and conservative treatment in patients with penile fracture. In 22 years we treated 29 patients with penile fracture. A total of 12 patients were treated with immediate surgical repair and 17 patients were treated conservatively. Patient charts were reviewed and all patients had followup by interview with an additional clinical evaluation if the result was not completely satisfactory. Outcome was rated good, moderate or poor. Mean followup was 67 months. There was no statistical difference between patients in the surgery group and patients in the conservative group in regard to length of followup, age at presentation or length of hospital stay. In the surgery group and the conservative group 11 (92%) and 10 (59%) patients showed good outcome, respectively. Poor outcome was seen in 3 patients from the conservative group. Overall, immediate surgery yields excellent results and is superior to nonoperative treatment in the management of penile fracture. However, conservative therapy restricted to uncomplicated cases can lead to an equally good outcome.
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                Author and article information

                Contributors
                Ming Kwong Yiu
                Journal
                Journal ID (nlm-ta): Asian J Urol
                Journal ID (iso-abbrev): Asian J Urol
                Title: Asian Journal of Urology
                Publisher: Second Military Medical University
                ISSN (Print): 2214-3882
                ISSN (Electronic): 2214-3890
                Publication date PMC-release: 06 July 2015
                Publication date (Print): July 2015
                Publication date (Electronic): 06 July 2015
                Volume: 2
                Issue: 3
                Pages: 175-178
                Affiliations
                [1]Division of Urology, Department of Surgery, University of Hong Kong, Pokfulam, Hong Kong, China
                Author notes
                [∗ ]Corresponding author. yiumk2@ 123456ha.org.hk
                Article
                Publisher ID: S2214-3882(15)00077-6
                DOI: 10.1016/j.ajur.2015.06.006
                PMC ID: 5730709
                SO-VID: c9fa7eb6-0818-4988-b1ca-54c28ec7bb4d
                Copyright statement: © 2015 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier (Singapore) Pte Ltd.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                Categories
                Subject: Article

                Keywords: penile fracture,urethral injury,penis,corpus spongiosum,urological trauma,urethroplasty
                Data availability:
                Keywords: penile fracture, urethral injury, penis, corpus spongiosum, urological trauma, urethroplasty

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