Penile Fracture

Fractured

Step 1: View clinicals

A 28 year old man presents with painful swelling and discoloration of his penis for 3 hours. During sexual intercourse immediately prior, he suddenly experienced severe penile pain in association with a 'crackling' sound, which was followed by immediate detumescence. He is able to urinate normally, and there is no history of dysuria or urinary discoloration. His medical history is unremarkable, and he is not on any medications. He drinks only socially, and does not smoke or use recreational drugs. Urinalysis reveals no red cells, while a dipstick test is negative for blood.


Step 2: Order all relevant investigations

Penile Ultrasound

The ultrasound scan shows a rupture in the tunica albuginea of the right side of the penile shaft, with an associated hematoma.

MRI Penis

Transverse images show a hyperintense area in the tunica albuginea on the right side of the penile shaft; this extends into the right corpus cavernosum. An overlying hematoma is also present. The urethra does not appear to be involved.

Retrograde Urethrography

The proximal urethra appears normal, with no evidence of rupture.

Cavernosography

There is a defect in right corpus cavernosum, with extravasation of contrast into the penile soft tissues.


Step 3: Select appropriate management

Urgent Surgery
Catheterization stat
Abstain from Sex for 3 months
Diethylstilbestrol


Score: ★★☆