(169) Penile Fracture and Urethral Injury Repair

Abstract

Abstract Introduction Penile fracture refers to the rupture of tunica albuginea of the penile corpora cavernosum which most often occur due to trauma during coitus or manual manipulation. This can be associated with either a partial or a complete urethral injury up to 39% of cases, usually those fractures crossing the septum. It is important to address both conditions to ensure sexual and voiding function is maintained. Objective The patient presented in this video is a 35-year-old gentleman who presented to the emergency department post-trauma related to sexual intercourse causing immediate detumescence and swelling. Methods This video describes the penile fracture repair performed using a midline ventral incision repair technique. Prior to surgery the patient is imaged, usually ultrasound, to allow location and marking of the suspected penile fracture. Due to the suspected urethral injury requiring a suprapubic catheter insertion at the presenting hospital, a flexible cystoscopy was performed initially. This showed the urethra was inaccessible at the level of the penile scrotal junction but within the penile urethra. A ventral midline incision along the penile raphe over the suspected fracture site is made. Dartos and Bucks Fascia were dissected to expose the tunica albuginea and allow identification of the fracture site. Further dissection was required to determine the lateral extents of the injury. Stay sutures can then be placed to allow easier closure of the injury. The tunica albuginea was then sutured with PDS sutures, care was taken to ensure these are buried sutures to ensure the patient is unable to palpate these. Subsequently, urethral injury was addressed by performing primary urethral anastomosis. A catheter was introduced through the urethra, a complete transection was seen and the ends were then dissected out to allow an end to end anastomosis to be performed. The anastomosis was checked for a leak with a table urethrogram using dilute betadine. Upon adequate closure of the urethra the ventral midline incision was closed. Results The procedure was successful and uneventful. He has a urethrogram 3 weeks post-op on which no evidence of a leak was shown. This patient went on to have good erectile function at 2 months post-operatively. However, he has a 30-degree ventral curvature which he finds bothersome. This is currently being treated conservatively with a vacuum device. Conclusions The BAUS consensus documents reports erectile dysfunction and penile curvature rates following surgery for penile fracture repair are reported to be 5% and 5% respectively. Conservative management results have a much higher rate of complication with 62% chance of erectile dysfunction and 35% chance of curvature. Disclosure No.