Penile fracture

Penile fracture refers to the traumatic rupture of the tunica albuginea and the corpora cavernosa of the penis. It is a rare condition that results from traumatic bending of the erect penis, typically during sexual intercourse or masturbation. Penile fractures usually present with acute pain and a cracking sound, accompanied by immediate loss of erection, as well as curving, swelling, and hematoma of the penis. In most cases, the diagnosis is established clinically, but imaging methods (e.g., ultrasound, MRI) may be needed in ambiguous cases. Retrograde urethrography is recommended in all cases of confirmed penile fracture to rule out concomitant urethral damage. Penile fracture is an acute urological emergency and requires immediate surgical treatment to avoid long-term complications, including abnormal curvature of the penis and erectile dysfunction.

• Traumatic rupture of the tunica albuginea and one or both of the corpora cavernosa of the erect penis

References:^[1]

• Traumatic bending of the erect penis
  • During sexual intercourse; most commonly occurs with the penetrative partner on top
  • Aggressive masturbation methods

References:^[1][2]

• Cracking, snapping, or popping sound caused by rupturing of the tunica albuginea and soft tissue
• Immediate detumescence (loss of erection)
• Pain; varies in intensity depending on severity of the injury
• Pronounced soft tissue swelling, curving, and hematoma of the penis (“eggplant” appearance)
• Blood at the urethral meatus, urinary retention, and/or gross hematuria in concomitant urethral injury

References:^[1][2]

The diagnosis of penile fractures is primarily clinical. Additional imaging is performed to diagnose ambiguous cases.

• Retrograde urethrography: performed if urethral injury is suspected before insertion of a transurethral indwelling catheter
• Imaging
  • Ultrasound: detection of hematoma and defects in the tunica albuginea
  • Corpus cavernosography: detects injury of the tunica albuginea
  • MRI: definitive exclusion of a fracture

References:^[1]

• Rupture of the dorsal vein of the penis

Peyronie disease

• Definition: : fibroproliferative disorder that affects the tunica albuginea of the penis, causing abnormal curvature of the penis
• Pathogenesis: repeated penile microtrauma during sexual intercourse or athletic activity followed by abnormal wound healing → fibrous plaque formation ^[3]
• Classification
  • Active phase
    • Acute or inflammatory phase
    • Characterized by progressive penile deformity and painful erection
  • Stable phase
    • Chronic phase
    • Characterized by the lack of progression of penile deformity and pain
• Clinical features
  • Penile pain
  • Penile nodules/indurations on the affected side of the penis
  • Erectile dysfunction due to abnormal curvature of the penis
  • Possibly associated with psychological conditions; (e.g., anxiety, depression) ^[4]
• Differential diagnosis
  • Penile fracture (penile injury → rupture of corpora cavernosa → penile curvature)
  • Chordee without hypospadias
• Treatment
  • Active phase: oral NSAIDs or oral pentoxifylline for 3 months
    • No symptomatic improvement: intralesional collagenase injections
    • Symptomatic improvement: observation or continuation of oral pentoxifylline for another 6 months
  • Stable phase
    • Observation: patients with a mild penile curvature (< 30°) and no erectile dysfunction
    • Intralesional collagenase injections: patients with penile curvature (> 30°) and/or erectile dysfunction
    • Surgical repair: patients unresponsive to treatment, with severe penile deformity, and/or with extensive calcifications

References:^[1]

The differential diagnoses listed here are not exhaustive.

• Surgical procedure
  • Exploration of the penis with evacuation of hematoma
  • Repair of possible urethral injury with insertion of a catheter for stenting purposes
  • Suture of rupture in the tunica albuginea
• Postoperative measures
  • Pain medication; prophylactic oral antibiotics
  • Light compression dressing
  • 4 weeks of sexual abstinence (suppression of spontaneous erections with diazepam or stilboestrol may be considered)
  • Follow-up with retrograde urethrography in patients with urethral reconstruction upon removal of the urethral catheter after 2 weeks

Penile fracture is a urological emergency and requires immediate surgical treatment to restore functionality and minimize risk of long-term complications!

References:^[1][2][5]

• Abnormal curvature of the penis
• Erectile dysfunction
• Painful erection
• Urethral stenosis

References:^[1]

We list the most important complications. The selection is not exhaustive.