蔡佳宏¹、張殷綸¹

高雄長庚紀念醫院 泌尿科¹

Chia-Hung Tsai¹, Yin-Lun Chang¹

Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan¹

 

Penile fracture is defined as rupture of the tunica albuginea. Patient may suffered from pain, rapid detumescence, and penile hematoma known as “eggplant deformity”. This emergency condition require urologist surgical intervention. Images such as echo and magnetic resonance imaging (MRI) help urologist to evaluate the equivocal case. We present a case who had fair erectile function after penile fracture for days and was diagnosed with pelvic CT scan.

  A 40-year-old man suffered from penis injury during masturbation. He heard a “popping” sound while bending his erected penis forward. He complained penis tenderness and rapid detumescence. Ecchymosis over penis, scrotum and pelvic area was noted after the trauma. He still had fair erectile function after injury. No voiding difficulty and hematuria during these days. He went to local hospital for help and the doctor suggested ice-packing and medical treatment first. However, the area of ecchymosis progressed to bilateral inguinal area after conservative treatment. He came to our emergent department (ER) after 3 days of the injury. Urologist was consulted and pelvis computer tomography (CT) with contrast was arranged for him at emergent department. One hyper-dense mass around 2.7 cm over left lateral aspect of the penis root with increase regional fat stranding was found and penile fracture was impressed.

  After penile fracture 4 days, this patient received operation. Circular incision was made over penile shaft for surgical exploration under general anesthesia. After circumferential degloving of penis till the root, one hematoma was found over left side of penile root. We removed the blood clots completely and one defect of tunica albuginea was found. We used Chromic 3-0 and prolene 4-0 to repair this defect and closed circular incision with Chromic 4-0. He was discharged from our ward two days after the operation. Sexual abstinence for one month was recommended for him. Fair morning erection function was told at outpatient department follow up after one month.

Penile fracture is a urological emergency condition. Delayed treatment may cause erectile dysfunction and penile curvature. Our patient still had fair erection function after the trauma may because that the hematoma over the penile root comprised the defect during the erection. This situation is rare and may cause delayed diagnosis. The penile doppler ultrasonography is highly operator dependent and relies on the proper interpretation of results by an urologist who is familiar with the disease. Besides, MRI are inconvenient at ER or ward. Due to above reason, we suggest that pelvic CT with contrast may be an alternative choice to confirm the penile fracture diagnosis of equivocal patient. Identify the tunica albuginea defect earlier and receive surgical repair may prevent further complications.