Penile fracture: Difference between revisions
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==Background== | ==Background== | ||
*Tunica albuginea of one or both corpus cavernosa ruptures due to trauma to erect penis | *Tunica albuginea of one or both corpus cavernosa ruptures due to trauma to erect penis | ||
*Can be | *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<ref>Wessells H et al. Penile and genital injuries. Urol Clin North Am. 2006 Feb;33(1):117-26</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
*Penis is swollen, discolored, tender, and flaccid | *Penis is swollen, discolored, tender, and flaccid | ||
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*Retrograde urethrogram may be necessary to assure urethral integrity | *Retrograde urethrogram may be necessary to assure urethral integrity | ||
**Especially important if patient unable to urinate | **Especially important if patient unable to urinate | ||
*Urology may request corpus cavernosography, MRI, or ultrasound if the penile fracture is atypical<ref>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</ref> | |||
==Treatment== | ==Treatment== | ||
* | *Surgical exploration required for most injuries if there is obvious or suspected fracture | ||
**Hematoma evacuation and suture apposition of the disrupted tunica albuginea | **Hematoma evacuation and suture apposition of the disrupted tunica albuginea | ||
*Penile Hematomas with no fracture can be treated with NSAIDs as an outpatient | |||
*Lacerations without fractures can be closed with 5-0 or 4-0 absorbable sutures | |||
==Disposition== | ==Disposition== | ||
Revision as of 17:25, 13 April 2014
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 swollen, discolored, tender, and flaccid
- Cracking sound followed by pain, detumescence, swelling, discoloration, deformity
Differential Diagnosis
Penile trauma types
Work-Up
- Retrograde urethrogram may be necessary to assure urethral integrity
- Especially important if patient unable to urinate
- Urology may request corpus cavernosography, MRI, or ultrasound if the penile fracture is atypical[2]
Treatment
- Surgical exploration required for most injuries if there is obvious or suspected fracture
- Hematoma evacuation and suture apposition of the disrupted tunica albuginea
- Penile Hematomas with no fracture can be treated with NSAIDs as an outpatient
- Lacerations without fractures can be closed with 5-0 or 4-0 absorbable sutures
Disposition
Admit
See Also
Source
Tintinalli