Penile trauma

Abstract

Penile trauma may include blunt, penetrating, and ischemic injuries.1Mydio JH Harris CF Brown JG Blunt, penetrating and ischemic injuries to the penis.J Urol. 2002; 168: 1433-1435Abstract Full Text Full Text PDF PubMed Google Scholar Infrequently, patients with these kinds of injuries present to an emergency department (ED), and not all emergency physicians may be familiar with the appropriate evaluation and management. Thus, time spent for diagnostic procedures may delay surgical intervention. A recent review performed by a MEDLINE search from 1966 to 20012Eke N Fracture of the penis.Br J Surg. 2002; 89: 555-565Crossref PubMed Scopus (172) Google Scholar found 183 publications reporting 1,331 cases. The United States and Canada reported the most cases individually (n=250), but the majority of reports (n=745) were from the Mediterranean region. The mean age was 40 years, and the most common causes were coitus and penile manipulation. During the past 11 years (1992 to 2002), we managed 33 cases at our institutions. Ages ranged between 18 and 78 years. Causes were coital (n=15) and noncoital (n=18). In all coital traumas, the corpum spongiosum was also involved. Most noncoital injuries were caused by operating machinery or working tools and presented concurrent scrotal or testicular lesions. Seventeen blunt injuries (8 coital, 9 noncoital) were managed nonoperatively, and conservative treatment resulted from delayed presentation, ranging from 3 days to several weeks. Sixteen cases (7 coital, 9 noncoital) underwent early surgery. After a simple ultrasonographic evaluation, early surgery (immediate exploration and repair) was performed. Early surgery allows the surgeon to face a limited hematoma, with minimal damage to the erectile tissue. When placement of a catheter is easy, the repair of ruptures of the spongiosum is uneventful. This is especially true in blunt injuries not requiring a suprapubic tube placement. In the early surgery group, hospital stay was always less than 72 hours, and all patients had no residual curvature. On the other hand, in the conservative group, all patients had a plaque (Peyronie's disease) requiring further surgical correction. The excellent outcome of our patients parallels other reports of early surgical repair,3El-Bhanasawy MS Gomha MA Penile fractures: the successful outcome of immediate surgical intervention.Int J Impot Res. 2000; 12: 273-277Crossref PubMed Scopus (64) Google Scholar regarding low morbidity, short hospital stay, and functional recovery. Because of the suggestive and typical presentation, including pain, detumescence, and hematoma, the diagnosis is largely clinical. However, cavernosography and urethrography have been recommended by some authors.4Beysel M Tekin A Gurdal M et al.Evaluation and treatment of penile fractures: accuracy of clinical diagnosis and the value of corpus cavernosography.Urology. 2002; 60: 492-496Abstract Full Text Full Text PDF PubMed Scopus (48) Google Scholar Cavernosography is easy to perform, with or without anesthesia, but is an invasive procedure sometimes associated with complications such as priapism or allergic reactions, and may give false-negative results. Magnetic resonance imaging is surely the most accurate investigative procedure, but high costs and delay in management are a limitation. For these reasons, ultrasonography still remains the cheapest and most useful investigative procedure, and cavernosography and magnetic resonance imaging should be limited to atypical cases or cases when a rupture of tunica is suspected.3El-Bhanasawy MS Gomha MA Penile fractures: the successful outcome of immediate surgical intervention.Int J Impot Res. 2000; 12: 273-277Crossref PubMed Scopus (64) Google Scholar As with most medical and surgical emergencies, when managing penile injuries, time is everything, and close collaboration between emergency physicians and urologists is helpful. Most cases could be managed quickly in the ED, on the basis of an easy flowchart including clinical evaluation and ultrasonography. Then, referring patients for early surgery repair may result in savings of time, money, and incidence of late complications.