- Published on
KembaraXtra -Medicine- Emergency and Acute Medicine – Penile Shaft Fracture
Penile shaft fracture is a traumatic rupture of the corpus cavernosum and its surrounding tunica albuginea, most often occurring during erection. The injury may also involve the corpus spongiosum and urethra, with urethral injury present in approximately 25–30% of cases. Hematoma formation occurs at the site of rupture, and the injury is typically unilateral and transverse, most commonly affecting the proximal shaft.
During erection, intracavernosal pressure rises to near arterial levels, expanding the corpora cavernosa and thinning the tunica albuginea, making it highly susceptible to rupture with blunt trauma. Because erection limits vertical movement while allowing lateral motion, forceful bending can create a vulnerable hinge point at the penile base. Penile fracture most commonly occurs during sexual intercourse, but can also result from manipulation, falls onto an erect penis, entanglement in clothing, or forceful detumescence practices such as “Taghaandan.” Predisposing factors include prior trauma, surgical procedures, Peyronie disease, urethritis, or scar tissue weakening the tunica.
Clinically, patients often report a loud “pop” or “crack” at the time of injury, followed by immediate detumescence and severe penile pain. Rapid swelling, ecchymosis, and deformity develop, often producing the classic “eggplant deformity” due to extensive hematoma. The penis deviates away from the side of the tear. Physical examination reveals a flaccid, swollen, ecchymotic penis with possible palpable defect along the shaft. Blood at the urethral meatus, hematuria, dysuria, urinary retention, or weak urinary stream suggests associated urethral injury. Late complications of untreated injury include erectile dysfunction, penile curvature, urethral stricture, and fistula formation.
Diagnosis is primarily clinical. Urinalysis should be performed to evaluate for urethral trauma. If urethral injury is suspected, retrograde urethrography should be performed before urethral catheterization and with low-pressure contrast injection. Ultrasound, cavernosography, or MRI may help confirm the tear or localize injury in equivocal cases, but imaging should not delay definitive management. Surgical exploration is recommended if clinical suspicion remains high, even when imaging is negative.
Emergency management prioritizes pain control and stabilization. Ice packs and elevation may help reduce swelling. In cases of urethral injury with urinary retention, suprapubic cystostomy may be required. Prophylactic antibiotics are generally unnecessary unless indicated for associated injuries. Urethral catheterization should only occur after urethral trauma has been excluded.
All patients with suspected penile fracture require urgent urologic consultation and hospital admission for prompt surgical repair. Early operative intervention significantly reduces complications such as erectile dysfunction, penile deformity, and urethral stricture. Delay in treatment is the primary cause of long-term morbidity. Follow-up with a urologist is essential to ensure restoration of normal urinary and sexual function.
Early recognition and timely surgical management are critical, as penile fracture is a urologic emergency with excellent outcomes when treated promptly.
0 Comments
