(101) Ultrasonography and Magnetic Resonance Imaging are Accurate for Suspected Penile Fracture

Abstract

Abstract Introduction Penile fracture (PF) is a rare but potentially catastrophic injury due to the risk of erectile dysfunction (ED) and penile curvature in young, sexually active men. The diagnosis is commonly made by clinical examination only but may be inaccurate in 15% of men. Despite this, penile ultrasound (US) and magnetic resonance imaging (MRI) remains poorly utilised. Objective This study aims to correlate for the first time imaging suggestive of PF with intraoperative findings as the gold standard comparator in order to calculate the sensitivity and specificity as accurately as possible. Methods Retrospective analysis (electronic and paper records) of all men referred for imaging querying penile fracture over ten years at a single centre (January 2010 - December 2020). All men with suspected PF on US and/or MRI were included. Same day MRI was performed in equivocal cases or to further define the extent of injury. Imaging findings were correlated with intraoperative findings. Results 114 men underwent surgical exploration for PF over 10 years with a median age of 39 years (range 16-74). Pre-existing ED was reported in 9 men and 6 men reported pre-existing Peyronie’s disease. Most men had a pre-operative doppler US (92.6%, n=112) with subsequent MRI in 13 men (11.6%). Two men were surgically explored after MRI only. Table 1 summarises the strong correlation between imaging and intraoperative findings. PF was not identified on US in 8 men (7.1%). MRI upgraded equivocal US findings to PF or showed a greater extent of injury in 76.5% (n=13). All PF were identified on MRI but there was a single false positive where PF was not found on exploration. MRI may have been confounded by Peyronie’s plaque calcification. Urethral injury was identified in 24 men intraoperatively but US only identified 10 with a further 4 identified on subsequent MRI. Conclusions Penile US has a high sensitivity and PPV for PF when compared to the gold standard of intraoperative findings. MRI has excellent specificity for both PF and urethral injury and should be considered in equivocal cases. The combination of US and MRI is useful to avoid unnecessary surgery and can characterise complex/atypical injuries to guide choice of incision and surgical planning. Imaging should be routinely offered to all men prior to surgical exploration. Disclosure No