You are here

Article Text

Article menu

Download PDFPDF

Penile fracture with urethral injury: evaluation by contrast imaging
Free
  1. Manish Garg,
  2. Apul Goel,
  3. Deepansh Dalela,
  4. Sachin Patil
  1. Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Manish Garg, dr_manugarg{at}yahoo.co.in

https://doi.org/10.1136/bcr-2013-010318

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Description

    A 50-year-old man presented with penile pain and swelling for 24 h prior to the visit. The patient revealed the sudden development of pain during intercourse with history of striking of the erect penis against the partner's perineum. He had the sensation of ‘tearing’, and rapid detumescence after that. He had slight haematuria initially but was able to void well. On physical examination, penile swelling was found but there was no blood at the urethral meatus (figure 1).

    Figure 1
    Figure 1

    Gross penile swelling.

    Retrograde urethrogram was suggestive of a rare and interesting image of a collection of the contrast agent in the ruptured corpora cavernosa which entered through urethral tear in the distal penile urethra (figure 2). The urethroscopy was suggestive of a rent (figure 3) in the right dorsolateral part of the distal penile urethra with collection of clots in the ruptured corpus cavernosum (figure 4).

    Figure 2
    Figure 2

    Retrograde urethrography image showing collection of contrast agent in the ruptured corpora cavernosa and periurethral planes (white arrow). Small streak of contrast going into normal urethra is also evident proximal to ruptured segment (black arrow).

    Figure 3
    Figure 3

    Urethroscopy image showing rent in the distal urethra (white arrow) with normal urethral lumen (black arrow).

    Figure 4
    Figure 4

    Collection of blood clots in the ruptured corpus covernosa.

    Surgical management was conducted immediately and after evacuation of blood clots, tear in the corpus cavernosum was sutured. The urethra was also repaired in a watertight fashion after spatulation and 16 F Foley catheter was inserted. In follow-up period the patient was asymptomatic with no complications.

    The penile fracture remains an uncommon entity and diagnosis is usually clinical.1 Any associated urethral injury usually occurs with penile fracture2 and should always be confirmed either by a cystoscopy at the time of repair or radiological imaging such as retrograde urethrography prior to surgical intervention.

    Learning points

    • A penile fracture is a rare urological emergency which may have devastating complications.

    • The possibility of urethral injury must always be kept in mind while evaluating such patients and contrast studies or endoscopic evaluation may prove helpful.

    • Timely intervention is utmost important in avoiding long-term morbidity.

    References

    1. ↵
      1. Choi MH,
      2. Kim B,
      3. Ryu JA,
      4. et al
      . MR imaging of acute penile fracture. Radiographics 2000;2013:1397–405.
      OpenUrl
    2. ↵
      1. Ibrahiem el-HI,
      2. el-Tholoth HS,
      3. Mohsen T,
      4. et al
      . Penile fracture: long-term outcome of immediate surgical intervention. Urology 2010;2013:108–11.
      OpenUrl
    View Abstract

    Footnotes

    • Contributors All the authors contributed significantly to the following in the preparation of this manuscript: conception and design, acquisition of the data or analysis and interpretation of the data; drafting the article or revising it critically for important intellectual content. MG has approved the final version published.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.