scholarly journals Diagnosis and treatment of penile injury: ten years experience of an emergency department

2020 ◽  
Vol 92 (3) ◽  
Author(s):  
Paolo Panella ◽  
Pietro Pepe ◽  
Michele Pennisi
Keyword(s):  
Emergency Department ◽  
Conservative Management ◽  
Spin Echo ◽  
Tunica Albuginea ◽  
Color Doppler ◽  
Post Contrast ◽  
Surgical Exploration ◽  
Penile Trauma ◽  
Linear Probe ◽  
Penile Injury

Introduction: To evaluate the imaging accuracy in the diagnosis and clinical management of penile injury.Materials and methods: From January 2010 to January 2020, 20 men (median age 40.2 years) were admitted to our Emergency Department with the diagnosis of penile injury; the penile trauma was related to sexual intercourse in 16 cases, masturbation in 3 cases and injury caused by the partner in 1 case. All the patients underwent accurate medical history, clinical examinations and diagnostic imaging. Color Doppler ultrasound (CDU) evaluation was performed by Logiq E9 ecograph (General Electric; Milwaukee, WI) supplied with a linear probe small (7.5-10 MHz); magnetic resonance image (MRI) examination was performed within 3-24 hours from the trauma using a 1.5 Tesla scanner, (ACHIEVA 3T; Philips Healthcare Best, the Netherlands) performing pre-contrast and post-contrast multi-planar turbo spin-echo T1 and T2-weighted sequences. Results: 15/20 (75%) men with high suspicion of the tunica albuginea rupture underwent surgical exploration; conversely, 5/20 (25%) patients underwent conservative management. CDU detected 11/15 (73%) fractures of the penis and in 8 of them the length of the rupture was underestimated (more than 5 millimeters). On the contrary, MRI diagnosed all the albuginea ruptures showed by surgical exploration, but underestimated the length of the lesions in 9/15 (60%) cases. The IIEF-5 score administered six months later penile trauma demonstrated a good performance in all the patients. Conclusions: In our series, all the patients with a tunica albuginea rupture < 5 mm. diagnosed by MRI were submitted to conservative management with a complete functional restitutio ad integrum.

Il contributo dell'eco color doppler nella valutazione dello scroto acuto

1994 ◽  
Vol 61 (1_suppl) ◽  
pp. 204-209
Author(s):  
C. Del Boca ◽  
A. Guardamagna ◽  
G. Corsi ◽  
A.C. Giuberti ◽  
C. Ferrari ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Spermatic Cord ◽  
Tunica Albuginea ◽  
Color Doppler ◽  
Doppler Frequency ◽  
Acute Scrotum ◽  
Linear Probe ◽  
The Us ◽  
Scrotal Hematoma ◽  
History Of

The Authors report their experience in the use of Echo color Doppler in acute scrotum. The study is based on the treatment on 121 patients from 2 to 43 years (mean 19 years) affected by acute scrotal disease using an Acuson 128 with a 7 MHz linear probe and a Doppler frequency of 5 MHz. Of 57 patients with a clinical diagnosis of acute torsion of the spermatic cord only 21 (36.8%) had an absence of blood flow confirmed echographically. In 55 patients with a clinical diagnosis of acute epididymal flogosis, 46 (83.6%) were confirmed echographically. In the other subjects 5 acute spermatic cord torsion (9.1%), 2 hematomas in testicular neoplasia (3.6%) and 2 spontaneous hematomas were discovered. In the remaining 9 cases, wjth a history of scrotal trauma, the echographic patterns showed a scrotal hematoma and the integrity of the tunica albuginea or the lack of it. After having compared the US color Doppler with other instrumental techniques for acute scrotum, the Authors conclude by considering this procedure the most indicated for all acute scrotal diseases.

Penile Fracture-Report of Two Cases and Review of Current Literature

KYAMC Journal ◽  
2019 ◽  
Vol 10 (2) ◽  
pp. 122-125
Author(s):  
Ashraf Uddin Mallik ◽  
Mostafizur Rahman ◽  
Fatema Bagum ◽  
Uttam Karmaker ◽  
Baikali Ferdous ◽  
...  
Keyword(s):  
Tunica Albuginea ◽  
Traumatic Rupture ◽  
Penile Fracture ◽  
Corpora Cavernosa ◽  
Effective Treatment Modality ◽  
Special Cases ◽  
History Of ◽  
Penile Injury ◽  
Urological Emergency ◽  
Erect Penis

Penile fracture is an uncommon urological emergency, especially in Bangladesh. The other name is traumatic rupture of the tunica albuginea and corpora cavernosa in the erect penis. It occurs when an erect penis face to buckle under the pressure of a blunt sexual trauma. Patient gives the typical history of immediate detumescence, severe pain, swelling and eggplant deformity of the penile shaft due to penile injury. Immediate surgical exploration and repair of corpora Cavernosa with tunica albugenia is the most effective treatment modality. In normal cases diagnosis is made from history, physical examination alone. In some special cases ultrasonogram, radiological images, including retrograde urethrography or cavernosography are mandatory for proper diagnosis. KYAMC Journal Vol. 10, No.-2, July 2019, Page 122-125

scholarly journals AB1076 COLOR DOPPLER HIGH- FREQUENCY ULTRASOUND OF DIGITAL ARTERIES IN PATIENTS WITH SYSTEMIC SCLEROSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1827.3-1827
Author(s):  
O. Alekseeva ◽  
N. Yudkina ◽  
A. Demina ◽  
A. Volkov ◽  
E. Nasonov
Keyword(s):  
Blood Flow ◽  
Systemic Sclerosis ◽  
Color Doppler ◽  
Laboratory Data ◽  
Clinical Signs ◽  
Vascular Complications ◽  
Nailfold Capillaroscopy ◽  
Exclusion Criterion ◽  
Digital Ulcers ◽  
Linear Probe

Background:Systemic sclerosis (SSc) can lead to vascular complications such as digital ulcers or pitting scars (DU/PS). These changes develop in most patients with SSc and exacerbate their condition. However, there are no methods for dynamic assessment of the vascular involvement. The dynamics of capillaroscopic changes is very slow.Objectives:The aim of the study was to compare blood flow parameters of digital arteries in SSc patients and healthy individuals and to compare with nailfold capillaroscopy and clinical signs of ischemia (DU/PS).Methods:32 SSc patients, mean age 49,5 [42,0; 59,0] yrs and 26 ‘healthy’, mean age 43,5 [33,0; 57,0], were included. Groups of patients differed by gender and age. The exclusion criterion was the presence of obliterating vascular disease of the upper extremities. An Esaote MyLab Twice US system with 22 MHz linear probe was used. A total of SSc patients and controls underwent Color Doppler ultrasonography (CDUS) of 376 (256 + 208) digital arteries to compare blood flow velocity, resistive indices (RIs) and presence of occlusion. Nailfold capillaroscopy, clinical and laboratory data were also evaluated.Results:In digital arteries, pulsatility index (PI), peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly lower and RI higher in SSc patients compared with controls (PSV: 13,28 [9,88; 16,7] vs17,45 [12,65; 22,5] cm/s, p=0,008; EDV: 2,68 [1,78, 4,05] vs 6,37 [4,75; 8,5] cm/s, p=0,000; RI: 0,78 [0,69; 0,81] vs 0,68 [0,59; 0,74], p=0,005; PI: 1,73 [1,32; 2,19] vs 1,22 [0,99; 1,55], p=0,002).We did not find any correlation between two methods. Also, we did not reveal any correlation between DU/PS, clinical, laboratory data and CDUS, but we found relationship between DU/PS and avascular areas or capillaroscopic findings (r= 0,37, p=0,045 and r= 0,40, p=0,03 correspondingly).Conclusion:Blood flow is significantly decreased in digital arteries in SSc, but clinical features of vasculopathy depend on microcirculatory disorders. It is important to continue research to find methods for dynamic evaluation of microcirculatory changes.References:noDisclosure of Interests:None declared

scholarly journals Ultrasound imaging of acute scrotum: Pictorial review with etiological correlation

2020 ◽  
pp. 90-109
Author(s):  
Anitha Mandava ◽  
Veeraiah Koppula ◽  
Rohit Yalamanchili ◽  
Dilip Yadav ◽  
Juluri Rakesh
Keyword(s):  
Color Doppler ◽  
Acute Scrotum ◽  
Imaging Features ◽  
First Line ◽  
Surgical Exploration ◽  
Pictorial Review ◽  
Pictorial Essay ◽  
Characteristic Imaging ◽  
Line Imaging ◽  
Urological Emergencies

High resolution ultrasound with color Doppler is the first-line imaging investigation in the evaluation of acute scrotum. It plays a crucial role in distinguishing urological emergencies necessitating immediate surgical exploration from those that can be managed conservatively. Acute scrotal pathologies can involve the scrotal sac or its contents like testis, epididymis and testicular appendages and could range from benign, self-limiting conditions to emergencies. In this pictorial essay, we briefly review the ultrasonographic technique, scrotal anatomy and characteristic imaging features of various pathologies presented as acute scrotum.

scholarly journals Case Report: Double penile fracture

F1000Research ◽  
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.

Quantitative analysis of unruptured intracranial aneurysm wall thickness and enhancement using 7T high resolution, black blood magnetic resonance imaging

2021 ◽  
pp. neurintsurg-2021-017688
Author(s):  
Xinke Liu ◽  
Junqiang Feng ◽  
Zhixin Li ◽  
Zihao Zhang ◽  
Qiang Zhang ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Wall Thickness ◽  
Signal Intensity ◽  
Spin Echo ◽  
Fast Spin Echo ◽  
Black Blood ◽  
Post Contrast ◽  
Isotropic Resolution ◽  
Aneurysm Size ◽  
Aneurysm Wall

BackgroundThis study was performed to quantify intracranial aneurysm wall thickness (AWT) and enhancement using 7T MRI, and their relationship with aneurysm size and type.Methods27 patients with 29 intracranial aneurysms were included. Three-dimensional T1 weighted pre‐ and post-contrast fast spin echo with 0.4 mm isotropic resolution was used. AWT was defined as the full width at half maximum on profiles of signal intensity across the aneurysm wall on pre-contrast images. Enhancement ratio (ER) was defined as the signal intensity of the aneurysm wall over that of the brain parenchyma. The relationships between AWT, ER, and aneurysm size and type were investigated.Results7T MRI revealed large variations in AWT (range 0.11–1.24 mm). Large aneurysms (>7 mm) had thicker walls than small aneurysms (≤7 mm) (0.49±0.05 vs 0.41±0.05 mm, p<0.001). AWT was similar between saccular and fusiform aneurysms (p=0.546). Within each aneurysm, a thicker aneurysm wall was associated with increased enhancement in 28 of 29 aneurysms (average r=0.65, p<0.05). Thicker walls were observed in enhanced segments (ER >1) than in non-enhanced segments (0.53±0.09 vs 0.38±0.07 mm, p<0.001).ConclusionImproved image quality at 7T allowed quantification of intracranial AWT and enhancement. A thicker aneurysm wall was observed in larger aneurysms and was associated with stronger enhancement.

scholarly journals Intra-Testicular Papaverine Injection for Testicular Salvage after Blunt Testicular Trauma: A Case Report

2019 ◽  
Vol 13 (2) ◽  
pp. 110-112
Author(s):  
Kevin Keating ◽  
Paulette C. Dreher ◽  
Jason Levy ◽  
Brian McGreen ◽  
Daniel Edwards ◽  
...  
Keyword(s):  
High Speed ◽  
Motor Vehicle ◽  
Primary Repair ◽  
Tunica Albuginea ◽  
Current Evidence ◽  
Common Mechanism ◽  
Surgical Interventions ◽  
Surgical Exploration ◽  
Valuable Treatment ◽  
Testicular Trauma

Blunt trauma is the most common mechanism of injury to the scrotum and testicle. Surgical exploration with primary repair, hematoma evacuation, and de-torsion are common surgical interventions. A 20-year-old male with no previous medical history presented after a high-speed motor vehicle collision. Ultrasonography demonstrated heterogeneous changes of the tunica albuginea and decreased arterial flow to bilateral testicles. He was subsequently taken to the operating room for surgical exploration, which revealed bilateral mottled testes with questionable viability. Papaverine was injected into each testicle, which resulted in visibly increased perfusion and subsequent preservation of the testicles. Conclusion: Current evidence on the use of papaverine is isolated to testicular torsion. Additional research should be conducted on the use of papaverine in blunt testicular trauma. Papaverine injection may be a valuable treatment option when inadequate perfusion is observed intra-operatively.

Delayed presentation and conservative management of an odontoid basilar synchondrosis fracture in a child

2008 ◽  
Vol 1 (5) ◽  
pp. 402-405 ◽  
Author(s):  
Kenneth M. Crandall ◽  
Esperanza Pacheco-Jacome ◽  
David I. Sandberg
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Neck Pain ◽  
Conservative Management ◽  
Delayed Presentation ◽  
Imaging Studies ◽  
Bone Fusion ◽  
Cervical Orthosis ◽  
Computed Tomography Scans

✓ The authors report the case of a 3-year-old boy who presented with neck pain after falling from a low height and who was discharged from the emergency department after imaging studies were noted to be normal. He presented again 2 months later with continued neck pain, and repeated imaging demonstrated a fracture of the odontoid basilar synchondrosis that had not been shown on the initial studies. Based on the normal alignment of his spine and evidence of early bone fusion at the time of his second presentation, he underwent cervical orthosis therapy only. To the authors' knowledge, this is the first reported case of an odontoid synchondrosis fracture in which computed tomography scans were normal at presentation.

scholarly journals Urethral pseudodiverticulum secondary to penile fracture and complete urethra dissection

2013 ◽  
Vol 7 (5-6) ◽  
pp. 347 ◽  
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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