An Atypical Presentation of Penile Fracture with Urethral Injury

Abstract

Background: Penile fracture is a urological emergency that occurs following a traumatic rupture of the tunica albuginea. Patients experience an audible ‘pop’ and immediate detumescence during sexual activity, followed by pain, swelling and ecchymosis. It is uncommon for patients to present without these typical clinical findings. Case Presentation: This case report describes a 33-year-old male with an atypical penile fracture and associated urethral injury. He reported mild pain as his penis buckled against his partner’s thigh during sexual intercourse and a sudden detumescence. Examination was unremarkable other than gross blood at the external urethral meatus. MRI identified a 4 mm focal capsular defect at the ventral aspect of the left corpora cavernosum. Flexible cystoscopy identified a 2cm longitudinal tear in the distal urethra. The patient underwent successful surgical repair with no long term sequalae. Conclusions: The authors of this report wish to highlight the importance of keeping a high index of suspicion for penile fractures in light of a typical history.