Primary urethral reconstruction results in penile fracture

Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed. From the third month after surgery, all patients were interviewed using the International Prostate Symptom Score questionnaire and uroflowmetry. Retrograde urethrocystography was used in patients with urinary symptoms or altered uroflowmetry to rule out or confirm urethral stenosis. Results Of 175 patients with penile fractures, 27 (15.4%) had associated urethral injury. All patients were diagnosed with penile fracture by means of clinical history and physical examination. No subsequent examinations were conducted. Ages varied from 30 years to 58 years old (mean 39.2 years). All fractures resulted from sexual activity. Reported sexual positions were ‘doggy style’ position in eight cases (61.5%) and with the ‘man on top’ in five cases (38.4%). Ten patients (76.9%) experienced haematuria, ten (76.9%) had urethral bleeding and four (30.7%) suffered urinary retention. Unilateral and bilateral injury of the corpus cavernosum was observed in four (30.7%) and nine (69.2%) patients, respectively; partial injury was found in nine cases (69.3%) and complete urethral injury was noticed in four cases (30.7%). All cases of complete urethral injury were associated with bilateral lesion of the corpus cavernosum. Six patients who had uroflowmetry with maximum urinary flow rate below 15 ml/s and/or had IPSS above 7 underwent retrograde urethrocystogram, and this was normal in all cases, excluding the possibility of urethral stenosis. Two patients (15.3%) experienced surgical postoperative complications represented by an urethrocutaneous fistula and a subcutaneous abscess adjacent to the end-to-end anastomosis area. Conclusions Penile fracture is a rare urological emergency, especially when it is associated with a urethral lesion. This must be suspected when the clinical picture is suggestive or in cases of high-energy trauma, especially in bilateral lesions of the corpus cavernosum. Complementary imaging methods are not needed in these cases and immediate exploration should not be delayed. Primary urethroplasty produces satisfactory results with low complication levels. Nonetheless, prospective studies with larger samples should be conducted.

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Urethral pseudodiverticulum secondary to penile fracture and complete urethra dissection

Canadian Urological Association Journal ◽

10.5489/cuaj.1209 ◽

2013 ◽

Vol 7 (5-6) ◽

pp. 347 ◽

Cited By ~ 4

Author(s):

Giovanni B. Di Pierro ◽

Luca Iannotta ◽

Michele Innocenzi ◽

Caterina Gulia ◽

Vincenzo Gentile ◽

...

Keyword(s):

Physical Examination ◽

Surgical Repair ◽

Tunica Albuginea ◽

Urinary Flow ◽

Suprapubic Catheter ◽

Penile Fracture ◽

Surgical Exploration ◽

Corpora Cavernosa ◽

Full Bladder ◽

Urethral Lesion

A 22-year-old man reported cracking sound and acute pain during sexual intercourse followed by rapid penile detumescence and ecchymosis. He experienced more pain because he could not urinate and had a palpably full bladder. Moreover, his urethra was bleeding. Physical examination revealed swollen, ecchymotic and deviated penis and penis ultrasonography showed an injury of the tunica albuginea and Buck’s fascia with an expanding hematoma. Suprapubic catheter was positioned. Surgical exploration revealed a tear of tunica albuginea of both corpora cavernosa and complete urethral dissection. End-to-end urethral anastomosis and suture of corpora cavernosa lesion were performed. Vescical catheter was mantained for 6 days and suprapubic catheter for 3 months to allow a complete urethral healing. A pseudo diverticulum was found atanastomosis level on the urethrocistography 1 month after surgery. It disappeared by allowing micturition via the suprapubic catheter. The patient presented regular urinary flow and physiological erections 30 days later. In our experience, prompt surgical repair preserved erectile function and keeping the suprapubic catheter protected the urethra; this was the correct management for repairing the urethral lesion.

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Non sex-related subtotal rupture of the corpus cavernosum without urethral injury: A case report and literature review

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2016.3.233 ◽

2016 ◽

Vol 88 (3) ◽

pp. 233 ◽

Cited By ~ 1

Author(s):

Zeki Bayraktar ◽

Selami Albayrak

Keyword(s):

Surgical Repair ◽

Tunica Albuginea ◽

Correct Diagnosis ◽

Corpus Cavernosum ◽

Early Surgery ◽

Urethral Injury ◽

Penile Fracture ◽

Minimal Rate ◽

The Right

Although penile fracture is a rare case, it is a well-described urologic emergency. It results from the rupture of the tunica albuginea of corpora cavernosa by blunt strain that commonly mandates immediate surgical exploration. Urethral injury may also accompany penile fracture. An ideal anamnesis and a special physical examination were determinant to achieve a correct diagnosis. It is usually diagnosed based on clinical examination, but ultrasonography can be very helpful in diagnosis. The treatment is based on the presence of associated urethral injury. Early surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications. The surgical repair of cavernous body can produce good results, with a favorable prognosis and minimal rate of complications. We present a penile fracture case of 34-year-old with subtotal rupture of the right corpus cavernosum without urethral injury who treated by early surgery and good results.

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Isolated corpus spongiosum injury after sexual intercourse

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2018.4.295 ◽

2019 ◽

Vol 90 (4) ◽

pp. 295-296 ◽

Cited By ~ 2

Author(s):

Ioannis Anastasiou ◽

Aikaterini Anastasiou ◽

Ioannis Katafigiotis ◽

Dimitrios Tsavdaris ◽

Constantinos Constantinides

Keyword(s):

Sexual Intercourse ◽

Sexual Trauma ◽

Urethral Injury ◽

Corpus Spongiosum ◽

Mechanism Of Injury ◽

Penile Fracture ◽

Simple Closure ◽

Corpora Cavernosa ◽

Absorbable Sutures ◽

Cardinal Sign

Penile fractures are generally rare and underreported. The mechanism of injury is due to a rupture of the corpora cavernosa following blunt or sexual trauma to the penis when fully erect. Penile fractures usually present with a ‘popping’ sound with concomitant sudden swelling and ecchymosis of the penis followed by rapid detumescence. Urethral involvement occurs only in a small part of the cases. Isolated spongiosal injury after sexual intercourse is also extremely rare. The cardinal sign of urethral injury is blood at the meatus. A small laceration can be repaired by simple closure with absorbable sutures, while a complete rupture requires a more complex anastomotic repair. We report a case of a typically presenting penile fracture that was eventually proven to be an isolated corpus spongiosum injury, with no corpora cavernosa involvement.

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Penile Fracture: Simultaneous Complete Urethral Rupture with Bilateral Corpora Cavernosa Rupture

Case Reports in Urology ◽

10.1155/2018/4929518 ◽

2018 ◽

Vol 2018 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Ibrahim Alnadhari ◽

Osama Abdelhaleem Abdeljaleel ◽

Venkata Ramana Pai Sampige ◽

Ausama Abdulmuhsin ◽

Ahmad Shamsodini

Keyword(s):

Blunt Trauma ◽

Sexual Intercourse ◽

Rare Case ◽

Urethral Injury ◽

Penile Fracture ◽

Surgical Exploration ◽

Corpora Cavernosa ◽

Retrograde Urethrogram ◽

Proximal Urethra ◽

Urethral Rupture

Penile fracture is not uncommon blunt trauma to the penis. Here, we present a rare case of penile fracture during sexual intercourse. The patient presented with penile swelling, bleeding per urethra, and inability to pass urine. Retrograde urethrogram showed significant extravasation of contrast from anterior penile urethra and no contrast passing to proximal urethra. Surgical exploration showed complete urethral rupture and bilateral cavernosal rupture. This case represents the value of urethrogram to evaluate the urethral injury and the association of complete urethral injury with bilateral ventral cavernosal injury.

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Urinary and sexual functions after surgical treatment of penile fracture concomitant with complete urethral disruption

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2014.1.15 ◽

2014 ◽

Vol 86 (1) ◽

pp. 15 ◽

Cited By ~ 5

Author(s):

Ali Abdel Raheem ◽

Hassan El-Tatawy ◽

Ahmed Eissa ◽

Abdel Hamid Elbahnasy ◽

Mohamed Elbendary

Keyword(s):

Case Series ◽

Surgical Reconstruction ◽

Urethral Injury ◽

Penile Curvature ◽

Retrospective Case ◽

Penile Fracture ◽

Case Series Study ◽

Long Term Follow Up

Objectives: Penile fracture with concomitant complete urethral disruption is an uncommon urologic disorder. Data about the treatment and outcome measurements of this condition are scarce in the literature. The aim of the present study is to evaluate the long term urinary and sexual functions of patients with penile fracture associated with complete urethral injury after immediate surgical reconstruction. Patients and methods: Twelve patients met our inclusion criteria and were included in this retrospective case series study; however, one was lost during follow-up. Patient's medical records were reviewed and all patients were interviewed for clinical evaluation. Urinary function was assessed by history, uroflometry and retrograde urethrography, while, sexual function was assessed by questionnaire (Sexual Health Inventory for Men) and penile Doppler for patients with erectile dysfunction. Results: Patients’ mean age was 32.3 ± 7.5 years (range 21-43) and the mean follow-up period was 72.6 ± 45.4 months (range 14-187). Vigorous sexual intercourse was the main cause in 91% of our patients. No serious long term complications was found. Only 1 patient (9%) suffered from anterior urethral stricture, 1 patient (9%) complained of weak erection, 3 patients (27%) had a palpable fibrosis and 2 patients (18%) reported a slight penile curvature during erection. Ninety one percent of all our patients maintained their normal urinary and sexual functions. Conclusion: On the long term follow-up, most of the patients maintained their normal erectile and voiding functions with no harmful long-term complications. We advocate immediate surgical intervention and reconstruction of both corpora cavernous and urethra as a first line treatment for those patients.

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Case Report: Double penile fracture

F1000Research ◽

10.12688/f1000research.16452.1 ◽

2018 ◽

Vol 7 ◽

pp. 1828

Author(s):

Felipe Mercado-Olivares ◽

J. Antonio Grandez-Urbina ◽

Giomar Farfan-Daza ◽

Juan Pacheco-Sauñe ◽

Luciano Nuñez-Bragayrac

Keyword(s):

Tunica Albuginea ◽

Young Male ◽

Successful Outcome ◽

Urethral Injury ◽

Penile Shaft ◽

Post Injury ◽

Penile Fracture ◽

Surgical Exploration ◽

The Third ◽

Corpora Cavernosa

Penile fracture is an underreported surgical emergency. It usually occurs as a single rupture of the tunica albuginea in one of two corpora cavernosa; a rupture of both masses is an uncommon finding. We report a case of a young male who presented to the emergency department two hours after sustaining penile trauma. Prompt surgical exploration was performed four hours post-injury. He was found to have one fracture on each corpora cavernosa, without urethral injury, which were repaired successfully. The patient had a favorable recovery and was discharged on the third postoperative day without complications. The aim of this report is to highlight the importance of complete degloving of the penile shaft for a meticulous search during surgery to avoid missed injuries. This approach will ensure a successful outcome avoiding physical and psychological disabilities.

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Clinical application of the anterolateral thigh free flap in high energy injuries of the lower extremity

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20211374 ◽

2021 ◽

Vol 9 (4) ◽

pp. 1192

Author(s):

Del Carmen-Ortega Ignacio ◽

Cahuana-Quispe Alberto Ignacio ◽

Jaimes-Duran Edwing Michel ◽

Soulé-Martínez Christian Enrique

Keyword(s):

Lower Extremity ◽

Free Flap ◽

Donor Site ◽

High Energy ◽

Road Accident ◽

Anterior Tibial Artery ◽

Osteosynthesis Material ◽

Anterior Tibial ◽

End To End ◽

The Right

One of the recurring problems in plastic and reconstructive surgery is the loss of tissues of the lower extremities as a result of high-energy injuries. The difficulty of this reconstruction lies in the need for a sufficiently suitable and resistant tissue to allow this restoration. The thigh-free anterolateral flap, since its description in 1984, has great versatility for complex or extensive lower extremity reconstructions. We presented the case of a 37-year-old male patient who had a high-energy road accident on a bicycle, impacting a moving vehicle causing a multi fragmented fracture of the right proximal tibia AO 41 C2.2/Schatzker V. He was treated surgically with material from osteosynthesis and iliac crest graft. It is complicated by infection of the surgical wound, exposure of osteosynthesis material and absence of skin covering. Reconstruction of the upper third of the right leg was performed with a thigh-free anterolateral free flap with 2 end-to-end venous anastomoses from the flap to anterior tibial veins, and 1 end-to-end anastomosis from perforating artery to anterior tibial artery, with no associated complications. The thigh-free anterolateral free flap is a versatile and reliable mechanism for the reconstructive surgeon, as it provides excellent coverage for complex lower extremity wounds as well as low donor site morbidity. Outpatient follow-up with adequate clinical evolution was done.

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