Abstract
BackgroundPenile curvature in men with Peyronie’s disease (PD)—caused by tunica anchoring plaques with loss of focal fiber elasticity—theoretically increases the risk of penile fracture during sexual activity. Penile fracture is the result of tearing of the tunica albuginea of one or both corpora cavernosa, usually during sexual intercourse, and is among the most serious urological emergencies. Generally, a patient presented to a surgical emergency within 48 h of injury can be handled successfully with minimum complications. Immediate surgical treatment is the current standard of care and has a relatively low risk of late complications.Case presentationWe present a case of penile fracture in a male with a history of PD referred to the emergency department with severe pain. Clinical history assessment and physical examination revealed a penile fracture with underlying PD. He underwent emergency surgical exploration via subcoronal incision. Penile plication was not necessary for our case because the angulation of the penis was less than 15° after examination of artificial erection.ConclusionPenile fracture in a patient with underlying PD is a rare urological emergency that should be treated surgically with fracture repair as early as possible. Penile plication might be necessary in severe cases (angulation > 60°).
Highlights
Penile curvature in men with Peyronie’s disease (PD)—caused by tunica anchoring plaques with loss of focal fiber elasticity—theoretically increases the risk of penile fracture during sexual activity
Penile fracture in a patient with underlying PD is a rare urological emergency that should be treated surgically with fracture repair as early as possible
Penile fracture is among the most serious urological emergencies and is caused by a tear in the tunica albuginea and enclosed corpus cavernosum, which is often caused by anal intercourse, vigorous vaginal intercourse, masturbation, or any mechanical trauma that causes forcible bending of an erect penis [2]
Summary
The first penile rupture case was reported in 1957 by Fernostrom, who recommended surgical intervention after prolonged observation [1]. The etiology of PD remains unclear, several theories have been proposed, and penile trauma is a widely accepted hypothesis [5]. This microvascular shear injury leads to inflammation, fibrin deposition, fibroblast activation, and results in the formation of a fibrous scar [4]. Subsequent artificial erection after intracavernous saline injection displayed lateral penile curvature less than 15°. We assumed this patient did not require penile plication. At regular follow up of 6 months, the patients reported normal erection and sexual activities
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