最初診斷為陰莖骨折的嵌頓性包莖 – 案例報告

曾博鴻、嚴孟意

彰化基督教醫院 外科部 泌尿科

Initial diagnosis as penile fracture in the case of paraphimosis – a case report

Po-Hung Tseng, Meng-Yi Yan

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Introduction

Penile fracture refers to the rupture of the tunica albuginea. This condition typically occurs when there is a sudden, forceful bending of the erect penis, often during sexual activity. Symptoms may include a popping or cracking sound, immediate loss of erection, severe pain, swelling, and bruising.

Paraphimosis is a medical condition in which the foreskin, once retracted, becomes trapped behind the glans penis and cannot be pulled back to its original position. This can lead to swelling, pain, and potential complications due to reduced blood flow to the glans.

We herein reported a case of a 73-year-old male with initial diagnosis as penile fracture in the case of paraphimosis.

Case report

A 73-year-old male with history of Parkinsonism and benign prostatic hyperplasia status post transurethral resection of prostate. The patient came to emergency department due to penile pain, swelling, and curvature, along with difficulty urinating for three days. The patient reported a history of trauma to the erect penis three days ago, There were no visible wounds but presenting with a dark color and swollen appearance resembling an eggplant deformity. CT scan revealed a hematoma around the penis foreskin. Due to the possibility of penile fracture not being ruled out, the patient underwent exploratory surgery. Intraoperatively, the diagnosis was paraphimosis, which was treated with a dorsal slit, confirmed erectile function with artificial erection at the end. One week postoperatively, the condition stabilized, and the patient was discharged after the removal of the Foley’s catheter. During one month of outpatient follow-up, ischemic and gangrene changes in glans of penis became apparent. In the presence of ineffective medical treatment and wound infection and suppuration, the patient ultimately underwent partial penectomy.

Conclusion

        The clinical presentation and diagnosis of penile fracture and paraphimosis are different, but both of them are typically based on clinical evaluation and a thorough medical history. Diagnostic imaging, such as ultrasound or MRI, may be used to confirm the diagnosis and assess the extent of the injury. Timely medical intervention, often involving surgical repair, is crucial to prevent complications and ensure optimal outcomes.