Post-Coital Traumatic Rupture of the Corpus Cavernosum: A Case Report

Penile fracture is a rare traumatic injury of an erect phallus involving mainly the tissues responsible for penile erection, corpora cavernosa, and penile sheath, which occur commonly, but not solely during vigorous sexual intercourse. Here, we present a 34-year-old man who presented with a 5-h history of snapping sound heard during sexual intercourse with subsequent loss of tumescence, swelling of the phallus, and assumption of abnormal contour, scrotal swelling, and lower anterior abdominal swelling. On examination, the patient was in severe painful distress with swelling around the external genitalia and lower abdomen and dorsolateral penile angulation with marked tenderness. The diagnosis of penile fracture was made; intraoperatively, there was a complete rupture of both corpora cavernosa and corpus spongiosum, complete disruption of the urethra, and buck’s fascia tear causing haematoma and urine extravasation into the scrotum and anterior abdominal wall. The patient had haematoma evacuation, corpora repair, and urethroplasty done, did well, and has been on follow-up for 2 years with good erectile and voiding functions.

Penile fracture is an unusual though not a rare condition but underreported. It is defined classically as the disruption of the tunica albuginea with rupture of the corpus cavernosum. Penile fracture can be misdiagnosed with rupture of corpus spongiosum clinically. Therefore, we are presenting three cases due to its varied clinical presentation and management. In first patient, there was a tear in the corpus spongiosum and a partial tear in the ventral urethra. Both defects were repaired with interrupted sutures. In the second patient, there was a rupture of corpus cavernosum, which was primarily repaired. After 1-year of primary surgery, patient again came with similar complaints, and diagnosis of scar dehiscence was made. Patient was treated conservatively with satisfactory results on follow-up. Third patient came with a history of 1-week. Intra-operative findings revealed only hematoma without any defect in corpora cavernosum, corpus spongiosum, and urethra. Only evacuation of hematoma was done. Early surgical treatment of penile fracture is advantageous. In recurrent penile fracture, if no penile deformity or any reasonable clinical and radiological evidence, then conservative management is advocated. Even when presentation is delayed up to 1-week, operative management has shown good results.

Introduction:Penile fractures are a rare urological emergency. It is defined as ‘rupture of the tunica albuginea of one or both corpora cavernosa. The corpus spongiosum and the urethra may also be involved in this process.’ The tunica albuginea is stiff and significantly thinner during erection than in the flaccid state, which is when injury generally happens.Method:This case series was completed between January 2018 and January 2023 at the Department of General Surgery. Eighteen patients suspected of having penile fractures participated in were included this study. All patients were thoroughly evaluated upon hospital admission to identify the diagnosis, length of time since the accident, the site of the fracture, the extent of the penile hematoma, occurrence of blood at the external meatus, presence of urine retention, and intraoperative outcomes.Results:The patients were between the ages of 24 and 70, with a mean age of 37. The duration before the presentation ranged from 7 h to 1 month (the median was 22 h). Sexual intercourse was the cause in 12 (66%) cases, rolling in the bed in three cases (16%), and blunt trauma in three cases (kicking and the edge of the bed) (16%). Pain and swelling were present in all of the patients. In 15 patients (or 83%), there was evidence of penile deviation. At presentation, 15 (72%) patients reported experiencing rapid detumescence, discomfort, and penile swelling after hearing a cracking (popping) sound. None of these individuals experienced urine retention or urethral hemorrhage, and all were emptied on their own following the episode. Physical examination showed penile ecchymosis, swelling, and substantial discomfort when the penile shaft was examined. All but three patients had an evident penile deformity. Surgery was performed under spinal anesthesia in 14 (77.7%) patients. Four patients with a delayed presentation (more than 1 week) were managed conservatively.Conclusion:As a true urologic emergency, penile fractures should be treated immediately to reduce pain and swelling and ensure better functional and esthetic outcomes. Despite taking more time, a subcoronal circumcising degloving incision is the ideal method because it is exploratory and esthetically pleasing.

Background: One of the uncommon emergencies in urology is a penile fracture. Due to blunt trauma to the erect penis, the tunica albuginea of one or both corpus cavernosum was disrupted, a rare kind of urologic damage. Corpus spongiosum or urethral rupture and dorsal nerve and vascular injury may also be present. Here, we describe a penile fracture case that was successfully treated conservatively at Zainoel Abidin Hospital. Case report: A 38-year-old male who had been having sex an hour before and had meatal bleeding, a history of cracking noises, and rapid detumescence presented to the emergency room at Zainoel Abidin Hospital. The patient also had pain when urinating. Physical examination revealed an enlarged penis and meatal hemorrhage but no ecchymosis or eggplant-like appearance. No bladder is full. The Foley catheter was put in. on ultrasonography of the penile. The hematoma was present in the corpus cavernous and spongiosum, and the urethra lumen was uneven. A pendulous urethral rip about 5 mm in size was found during urethroscopy. After 2 days of observation, the erectile function returned without pain or menstrual blood. After two days of conservative therapy, the patient was discharged from the hospital. Conclusion: Conservative treatment of the penile fracture is still an option based on clinical findings in cases.

Penile fracture is defined as a traumatic rupture of either corpus cavernosum or the tunica albuginea; sometimes it can be both. It may be caused by exotic masturbation acts, sexual intercourse, or other trauma to this area. This can be accompanied by injury to the urethra, which is the cause of hematuria as a symptom for some patients. Typically, diagnosis of penile rupture or fracture depends on clinical examination and history told by the patients. We are stating the importance of medical imaging in the diagnosis of patients with penile fracture by presenting a case of patient suffered from penile fracture after a fall on his penis where it affected the erection of two-third of his penis. In which, the proper diagnosis by imaging studies and taking actions accordingly can save the patients from unnecessary surgeries that indeed increase the bill of the medical care directly and indirectly. Therefore, most patients can be diagnosed cost-effectively and treated surgically without a need to delay surgery, which is often the case if one was to resort to other investigations. Investigations such as retrograde urethrography for suspected urethral injury should only be used when the diagnosis of penile fracture is in doubt.

Penile fracture is an uncommon acute surgical emergency, typically occurring after sexual intercourse, self-manipulation and at times, may be accidental. We report here a 39-year male who attended the department of emergency with swelling and bruising of the scrotum and penis. Physical examination exhibited a diffuse abdominal and perineal ecchymosis. Imaging confirmed a crural penile fracture. Operative fixation was performed appropriately and satisfactory erectile function was reported at the follow-up. We report a very rarely documented case involving the penile crus fracture and its management. Key Words: Crus, Penile fracture, Surgical repair.

Specimens of penile erectile tissue from the corpus cavernosum (CC) and corpus spongiosum (CS) of beagle dogs were investigated with reference to morphological and functional aspects of the nitric oxide (NO) system. Using immunohistochemistry, the smooth muscle bundles of the CC were found to contain a rich innervation, as seen by the pan-neuronal marker, protein gene product 9.5. A large number of nerves also stained positively for acetylcholine esterase. There was a moderate to rich supply of nerves containing NO synthase, which was frequently co-localized with vasoactive intestinal polypeptide. CS preparations from the proximal penis (the spongious bulb) had an innervation similar to that of the CC. However, CS preparations from the distal penis had a distinctly lower density of nerves than the proximal part, and spongious tissue from the glans penis was practically devoid of nerves. In isolated preparations of proximal and distal CC and CS, contracted by noradrenaline, electrical field stimulation (EFS) produced frequency-dependent relaxations. The responses were less pronounced in preparations from the distal penis, particularly in the CS. Pre-treatment with the NO-synthesis inhibitor NG-nitro-L-arginine abolished all relaxations. Carbachol effectively relaxed noradrenaline-contracted strips. The responses were similar in proximal preparations from the CC and CS, and significantly less pronounced in strips from the distal penis. NG-nitro-L-arginine significantly reduced the relaxant effect of carbachol. Preparations of spongious tissue from the glans penis did not react to high potassium solution, addition of noradrenaline, or EFS. The results demonstrate regional differences within the CS, both in innervation and functional responses.

To review the preoperative diagnostic evaluation and surgical treatment of penile fracture, as the condition is a urological emergency that requires immediate surgical exploration and repair. Between January 2003 and October 2007 eight patients presented to the emergency department with penile fracture after sexual intercourse. The clinical presentation, preoperative evaluation and imaging, surgical technique, and postoperative care were assessed to determine the optimal patient outcome. Seven of the eight patients were treated surgically and one refused surgical intervention. Four cases involved unilateral corporal injury, two involved unilateral corporal injury with an associated urethral injury, and one involved bilateral corporal injury with an associated urethral injury. Although retrograde urethrogram were taken of all three urethral injuries, none of them revealed the injury. Diagnostic cavernosography or magnetic resonance imaging were not used in any of the patients. No complications occurred in the patients treated surgically. Preoperative imaging should not delay surgical repair. If an associated urethral injury is suspected, flexible cystoscopy is recommended in the operating room, as opposed to a retrograde urethrogram. A subcoronal circumcising incision is recommended to deglove the entire penile shaft and have complete access to all three corporal bodies, as well as the neurovascular bundle. Saline mixed with indigo carmine can be injected both into the corpora cavernosum or corpus spongiosum via the glans penis, after a tourniquet is placed at the base of the penis, to evaluate the surgical repair and to determine if there are any missed injuries.

Introduction: Penile fracture is a rare urological emergency characterized by the rupture of the tunica albuginea, commonly associated with trauma to one or both corpora cavernosa. In severe cases, additional damage to the corpus spongiosum and urethra can occur. Immediate surgical intervention is crucial for optimal recovery, reducing complications such as erectile dysfunction and urethral strictures. Objective: To present a rare case of penile fracture involving both corpora cavernosa and complete urethral rupture, managed surgically. A brief literature review is also included. Case Report: A 33-year-old male presented to the emergency department after hearing a snapping sound during sexual intercourse, followed by detumescence, urethrorrhagia, and penile pain. Initial misdiagnosis led to a delayed referral, at which point imaging confirmed bilateral fractures of the corpora cavernosa and complete urethral rupture. Surgical exploration revealed complete penile urethral avulsion. The patient underwent successful primary urethral anastomosis and repair of the tunica albuginea, followed by an uneventful postoperative recovery. At follow-up, the patient reported no urinary issues, preserved erectile function, and normal sexual activity. Discussion: The diagnosis of penile fracture is primarily clinical, often associated with sudden detumescence, penile deviation, and urethral bleeding. Imaging, such as ultrasonography or MRI, assists in confirming the diagnosis and identifying associated injuries. Immediate surgical repair is the treatment of choice, offering better functional outcomes compared to conservative management. In this case, early surgical intervention resulted in complete recovery without complications. Conclusion: Penile fracture with bilateral corporal injury and urethral rupture is a rare but challenging condition. Prompt diagnosis and early surgical repair are essential for favorable outcomes, as demonstrated in this case.

Penile fracture is defined as a tear of tunica albuginea that covers the corpus cavernosum during an erection. It is a rare finding that both the corpora cavernosum and corpora spongiosum are involved in penile fracture. Herewith, we reported a rare case of 44 years old presented with penile fracture during woman on top sex position with both corpora cavernosum and corpus spongiosum rupture with urethral disruption. On clinical examination, the penis was swollen, and there was a sudden loss of erection and ecchymosis. Cystoscopy examination revealed urethral rupture. Emergent surgical repair was then performed. During emergency surgery, we found a defect of 3 cm in bicorporal cavernosa with urethral and corpus spongiosum disruption. The penis was degloved, and debridement with water-tight suturing of tunica albuginea was performed to repair the tear in corpora cavernosa. End-to-end anastomosis urethroplasty with spatulation was also performed to repair the urethra. After 21 days following surgery, erectile function was good and no difficulties in voiding function as shown in uroflowmetry result with Qmax >15 mL/s. The patient had a favorable recovery. This was a rare case report, and with early and prompt surgical intervention, this case could result in a good outcome in preserving erectile function and voiding function.

Although nerves and vessels of the penis play important role in erection, there are few studies on their development in human fetus. Therefore, the objective of the present study is to analyze, quantitatively, in the corpora cavernosa and corpus spongiosum, the development of the nerves and vessels in the fetal penis at different gestational ages. Fifty-six fresh, macroscopically normal human fetuses aged from 13 to 36 weeks post-conception (WPC) were used. Gestational age was determined by the foot length criterion. Penises were immediately fixed in 10% formalin, and routinely processed for paraffin embedding, after which tissue sections from the mid-shaft were obtained. We used immunohistochemical staining to analyze the nerves and vessels in the corpus cavernous and in the corpus spongiosum. These elements were identified and quantified as percentage by using the Image-J software. The quantitative analysis showed that the percentage of nerves varied from 3.03% to 20.35% in the corpora cavernosa and from 1.89% to 23.88% in the corpus spongiosum. The linear regression analysis indicated that nerves growth (incidence) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.9421, p<0.0001) and (r2=0.9312, p<0.0001), respectively, during the whole fetal period studied. Also, the quantitative analysis showed that the percentage of vessels varies from 2.96% to 12.86% in the corpora cavernosa and from 3.62% to 14.85% in the corpus spongiosum. The linear regression analysis indicated that vessels growth (appearance) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.8722, p<0.0001) and (r2=0.8218, p<0.0001), respectively, during the whole fetal period studied. In addition, the linear regression analysis demonstrated a more intense growth rate of nerves in the corpus spongiosum during the 2nd trimester of gestation, when compared with nerves in the corpora cavernosa. In addition, the linear regression analysis demonstrated a more intense growth rate of vessels in the corpus spongiosum when compared with the corpora cavernosa, during the whole fetal period studied. In the fetal period, the human penis undergoes major developmental changes, notably in the content and distribution of nerves and vessels. We found strong correlation between nerves and vessels growth (amount) with fetal age, both in the corpora cavernosa and corpus spongiosum. There is significant greater proportional number of nerves than vessels during the whole fetal period studied. Also, nerves and vessels grow in a more intense rate than that of the corpora cavernosa and corpus spongiosum areas.

Severe penile fracture with bilateral corpus cavernosum rupture, complete urethral rupture and scrotal haematoma associated with sexual intercourse: A case report

Fracture of the penis is a rupture of the tunica albuginea of the corpus cavernosum, usually while the penis is rigid and erect. When erect, the albuginea layer stretches so far until its thickness reaches approximately 0.25 – 0.5 mm, compared with a 2 mm thick when flaccid. Thus the erect penis is much more vulnerable to serious damage from blunt trauma than the pendulous, flaccid penis. The most common cause of penile fracture is vigorous vaginal intercourse, more likely when woman is on top, but it can also occur during masturbation, forced bending of the erect penis or any mechanical trauma to the erect penis. The classic presentation described by the patient cracking or popping sound, followed by rapid detumescence, severe pain, ecchymosis of the penile skin, and swelling of the affected side with deviation of the penis shaft away from the affected side. In most cases, the penile fracture is a transverse corporeal tear close to the corpus spongiosum on the ventral aspect of penis shaft or on the lateral aspect and the tunical tear is usually 1 to 2 cm in length. The rupture can involve one or both corpora cavernosa as well as corpus spongiosum with the contained urethra therefore urethral rupture can also occur in. Most urethral injuries are associated with gross hematuria, blood at the meatus or inability to void, although the absence of these findings does not definitively rule aut urethral injury.

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations. The College regards the reporting elements in the ‘‘Surgical Pathology Cancer Case Summary (Checklist)’’ portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice. The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of these documents. PROTOCOL FOR THE EXAMINATION OF SPECIMENS FROM PATIENTS WITH CARCINOMA OF THE URETHRA

Background: Penile Fracture (PF), consider as uncommon emergency in the urological field occurring due to tear in the tunica albugina of the corpora cavernosa of the penis. Objective: This retrospective study aims to analyze the main presentation, management modalities and complications that occurred for the cases of penile fractures who are admitted to Al-Hilla teaching hospital over the last 10 years. Materials and Methods: Fifty-four patients who presented to our hospital with PF over a 10-year period from December 2006 to December 2016 were included in this study. Hospital records and data collected from all the urologists at Hilla Teaching Hospital using a direct questionnaire were evaluated for all patients with PF. All patients treated by immediate surgical exploration, hematoma evacuation and repair of the tear or tears founded. Results: Out of a total of 54 patients who are include in the study, there were 44 patients (81.48%) between 21 and 40 years old. Most of the injuries were on the left proximal side of the penis. In almost all of the cases, the patients were admitted for 2–4 days. All the patients were given intravenous antibiotics at the hospital and completed an oral course of treatment at home. Forty nine patients (90.7%) report satisfactory penile erection post operatively without pain. Rough sexual activity was the primary cause of the penile fractures in our study. Most patients presented within 4–24 h of sustaining the injury, and the rest presented within 1 day to 1 week. The injury was usually repaired immediately. Most patients reported that erectile function returned 2–7 days after surgery, while sexual intercourse returned 2 weeks after the surgery. Conclusions: Vigorous sexual intercourse is the most common etiological factor for fracture of the penis for cases included in this study. Surgical repair is associated with a low complication rate. According to the results of our study, immediate surgical repair is strongly recommended.