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Fracture of the penis
Last reviewed: 23.04.2024
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Fracture of the penis, amputation and penetrating injuries of the penis, traumatic damage to soft tissues are considered urgent urological situations and usually require surgical intervention.
The goals of treating these injuries are universal: preserving the length of the penis, erectile function, maintaining the ability to urinate while standing.
[Causes of the penile fracture
Fracture of the penis occurs classically, but not universally. About 60% of the fractures of the penis occur when you hit it during an erection. The lining is about 2 mm thick, but elastic, so its damage occurs more often during sexual intercourse during the rigidity of the penis with a sharp inflection of it. When striking during detemtsentsii bowl is observed subcutaneous hematoma without damage to the gallbladder shell. Fracture of the penis (subcutaneous rupture of the cavernous bodies) often occurs when a coarse intercourse occurs when the penis, slipping out of the vagina, is damaged as a result of rapid and intense bending of the erect penis with an emphasis on the pubic bone of a woman (symphysis) or perineum, of different authors, is from 2.2 to 10.3% of all lesions of the penis. In 10-25% fracture of the penis is accompanied by damage to the urethra and spongy substance.
Symptoms of the penile fracture
During the fracture of the penis, the patient experiences pain, the erection stops, after which internal bleeding begins, a hematoma appears, the penis deviates to the opposite side, the pain intensively increases, a shock is possible. The size of the hematoma of the penis, which occurs when the fascia fascia ruptures, depends on the extent of damage to the gallbladder and cavernous bodies.
It can be large, often accumulating blood spreads to the scrotum, pubis, perineum, inner thighs, anterior abdominal wall. The skin becomes cyanotic, eventually darkens. If the urethra is damaged during a fracture, a micturition delay may occur. If the hematoma is not expressed, then it is possible to probe the defect of the cavernous bodies. Often the edema can reach a large size, making it difficult for the palpation of the organ. In this case, ultrasound is used with dopplerographic mapping and x-ray studies (cavernography, urethrography).
Diagnostics of the penile fracture
Fracture of the penis is diagnosed in case of damage to the gallbladder shell of the cavernous bodies. In 10-22% of cases, damage to the cavernous bodies is combined with damage to the urethra. With concomitant urethra injury (observed in 25% of cases), urethrorrhagia is possible. Often men in connection with a sense of shame turn to the doctor with a delay (according to one study, in 89% of cases), on average 6 hours after the injury.
The diagnosis of a fracture of the penis is established on the basis of anamnesis, examination. Ultrasound of the penis, and if it is necessary to clarify the damage of the gallbladder shell, cavernography and MRI are shown , which allow to reveal the rupture of the gall-stone shell and decide on the need for surgical intervention. Cavernosography in most cases makes it possible to identify lesions of the penis that require prompt treatment, but is less informative in identifying deep vein injuries.
The use of MRI allows not only to more accurately detect defects of cavernous bodies, but also to clarify the presence and location of concomitant lesions (urethra, testicles) and the location of the hematoma. With urethro- gia or a macro or microhematuria detected during urine, retrograde urethrography is indicated to exclude trauma to the urethra. If during retrograde urethrography, extravasation of the contrast medium is observed with the involvement of cavernous bodies, then the need for carrying out cavernosography disappears.
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Treatment of the penile fracture
Treatment for a fracture of the penis depends on the extent of the hematoma and the size of the lesion of the gall bladder. With minimal damage, treatment can be limited to the same measures as with a contusion of the penis. For long-term lesions of the gallbladder and cavernous bodies, usually accompanied by massive hemorrhage, urgent surgical intervention is necessary, which necessarily includes opening the hematoma, removing blood clots, stopping bleeding, suturing the defect of the gallbladder and cavernous bodies (both absorbable and non-absorbable threads) and draining wounds in the area of hematoma. As a rule, such treatment gives good results.
In the early postoperative period, 8.7% of cases are infectious complications, late - impotence in 1.3%, and the curvature of the penis - in 14% of cases.
If the urethra is damaged in surgical treatment, restoration of the damaged urethra with an anastomosis end-to-end, after sparing refreshment of its ends and adequate drainage of the bladder, more often the suprapubic epicystostoma, is included.
In the postoperative period, antibiotic therapy with broad spectrum antibiotics, cold, adequate analgesic therapy and prevention of impotence are necessary.
Fracture of the penis is not treated conservatively, as in 35% of patients this is fraught with a serious danger of complications (abscess of the penis due to undiagnosed partial damage of the urethra, adhesive fibrosis, curvature of the penis, painful erection and development of the arteriovenous fistula), which can lead to the need for prompt treatment at a later date.