陰莖骨折臨床處理
劉瑞文、吳佳璋
衛生福利部立雙和醫院 泌尿科
Case report of penile fracture management
Liu Jui Wen, Wu Jia Zhang
Department of Urology, Shuang Ho hospital, Taipei Medical University, Taipei, Taiwan
Introduction: Penile fracture was disruption tunica albuginea with rupture of the corpus cavernosum. This situation often occurred during sexual intercourse. It can be well reconstructed under surgical exploration, then cosmetic and functional get adequate recovery. We present one case of penile fracture which’s clinical evaluation and management.
Case report: This years old male patient has past history of diabetes mellitus. This time he was suffered from penile swelling for 1 hour after sexual behavior. So he came to our emergency department for help. According to himself, his penis was not full-hardness due to DM for long time. That time sex behavior was under missionary position, intercourse was not so smoothly due to darkness. “Bo” sound was noted while strongly pumped then tenderness and penis swelling were noted. So he came to our ER for help. Physical examination showed left side of middle part penile shaft, extreme tenderness was noted. So operation was suggested and he accepted. During operation, circumcision wound was made and penile degloving was done. Rupture of tunica albuginea was noted after hematoma cleaning and fascia dissection. The rupture side was closure by 3-O vicryl string and wound was closure layer by layer. Wound recovery was well after operation. Penile axis was not deviated and erection function was intact. IIEF score showed no obvious decreasing.
Discussion: Penile fracture is associated with disruption tunica albuginea with rupture of the corpus cavernosum. It happens during sexual intercourse or masturbation. Most injury occurred on distal to suspensory ligament, ventral or lateral side due to thinnest layer of tunica albuginea. Diagnosis of fracture is made according to history or physical examination. History usually is told as cracking or popping sound then pain, tenderness, ecchymosis, swelling of penile shalf. There are two condition of Buck fascia broken or not. If Buck fascia is intact, hematoma was limited within skin and tunica. If it is broken, hematoma will extend to scrotum, suprapubis and perineum area. It is important to recognize whether urethra injury or not. Urethra injury rate about 3% to 20 %. Intraoperation flexible cystoscopy before Foley catheter insertion was suggested. Image study is no need for diagnosis but sonography is helpful. Surgical exploration is most recommending for management. Because most fracture occurred on ventral and lateral side, ventral vertical penoscrotal incision is most suggested. Or one incision of hematoma location is alternative option. Closure is using absorbable 2-O or 3-O string. Therapy with broad-spectrum antibiotics is recommended. Post trauma complication is long-term penile curvature, abscess or debilitating plaques. Optimal operation time is within 7 days and study shows no obvious complication after that.
In this case, history quite correspond to fracture. Physical examination is showed limited hematoma which reveal intact Buck fascia. Emergency operation for exploration was done in time and lesion was repaired well. Follow up clinical presentation is stable and no further sexual problem.