Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome
Article first published online: 15 AUG 2008
© 2008 THE AUTHORS. JOURNAL COMPILATION © 2008 BJU INTERNATIONAL
Volume 102, Issue 11, pages 1640–1644, December 2008
How to Cite
Kamdar, C., Mooppan, U. M.M., Kim, H. and Gulmi, F. A. (2008), Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome. BJU International, 102: 1640–1644. doi: 10.1111/j.1464-410X.2008.07902.x
- Issue published online: 21 NOV 2008
- Article first published online: 15 AUG 2008
- Accepted for publication 15 May 2008
- penile fracture;
To review the preoperative diagnostic evaluation and surgical treatment of penile fracture, as the condition is a urological emergency that requires immediate surgical exploration and repair.
PATIENTS AND METHODS
Between January 2003 and October 2007 eight patients presented to the emergency department with penile fracture after sexual intercourse. The clinical presentation, preoperative evaluation and imaging, surgical technique, and postoperative care were assessed to determine the optimal patient outcome.
Seven of the eight patients were treated surgically and one refused surgical intervention. Four cases involved unilateral corporal injury, two involved unilateral corporal injury with an associated urethral injury, and one involved bilateral corporal injury with an associated urethral injury. Although retrograde urethrogram were taken of all three urethral injuries, none of them revealed the injury. Diagnostic cavernosography or magnetic resonance imaging were not used in any of the patients. No complications occurred in the patients treated surgically.
Preoperative imaging should not delay surgical repair. If an associated urethral injury is suspected, flexible cystoscopy is recommended in the operating room, as opposed to a retrograde urethrogram. A subcoronal circumcising incision is recommended to deglove the entire penile shaft and have complete access to all three corporal bodies, as well as the neurovascular bundle. Saline mixed with indigo carmine can be injected both into the corpora cavernosum or corpus spongiosum via the glans penis, after a tourniquet is placed at the base of the penis, to evaluate the surgical repair and to determine if there are any missed injuries.