A Clinical Note on Penile Fractures
Penile fracture is an uncommon traumatic condition pertinent to the erectile tissue of an erect penis. This usually involves blunt trauma and tears in the outer covering (tunica albuginea) of the erectile tissue which is also known as corpora cavernosa.
The outer covering of the penile tissue grows thinner in an erect state and an extreme traumatic injury may end up in tears involving the areas where this covering is the most fragile.
Some notorious factors underlying the causation of penile fracture include overenthusiastic sexual intercourse (woman on top, enthusiastic downward bounce as penis slips out and…eek!) and occasionally aggressive masturbation practices (yeah, I know…it’s amazing what some people manage to do).
Epidemiological statistics reveal that this emergency surgical condition has been more commonly reported in the African and Middle Eastern countries.
Penile trauma may follow a vigorous contact of male penis with the female pelvic bone during intercourse. A classical hallmark in this scenario would be a popping sound coming from the erect penis which precedes an immediate loss of erection, accompanied by swelling and contusion of the penile shaft. Hematoma formation may involve the surrounding areas of scrotum and perineum as well.
In severely complicated cases, penile urethra may be ruptured and this may clinically present in the form of difficult and painful urination along with blood in urine. This can adversely alter a person’s sexual performance by causing visible structural deformities in the male copulatory organ.
The diagnosis is mainly based on clinical findings but an ultrasound or MRI (magnetic resonance imaging) scan is a useful modality of investigation as it may help localize the site of soft tissue trauma.
An immediate medical care must be sought if a patient suspects himself of having developed a penile fracture. Conservative management aims at effectuating rapid healing with the aid of surgical dressings, urinary catheterization and the introduction of anti-androgenic substances for limiting the frequency of penile erections.
Since conservative management is related to multiple complications such as soft tissue fibrosis, most of the penile injuries require an urgent surgical intervention where the penile shaft is repaired or reconstructed. The surgical procedure involves removal of hematoma, followed by localization and repair of the damaged covering of tunica albuginea. Surgical rehabilitation proves to be the most effective when performed within the first few hours of injury.
In addition, it is highly essential to rule out any urethral injury prior to surgical management. If found, the damaged urethra has to be adequately repaired through primary suture closure or grafting technique.
Penile fracture can prove to be devastating for the sexual longevity of an adult male. Long-term complications can be avoided if it is clinically recognized and managed at the earliest stage possible.