Penile fracture gif

Added: Porter Byrnes - Date: 17.04.2022 11:08 - Views: 29331 - Clicks: 5269

Introduction: Fracture of the penis is a rare urological emergency which occurs as a result of abrupt trauma to an erect penis. Immediate surgical repair is the standard of care and is superior to non-operative management due to excellent long term outcomes. A large percentage of the patients present late for treatment out of fear or embarrassment.

We report our series of patients who presented late and underwent delayed repair. We also report the long term outcome in these patients. Heterosexual inter- course was the most common cause of fracture 18 patients, The mean time duration between injury and presentation was The mean time duration between presentation and surgical intervention was 4. Seventeen At the end of 1 year follow-up all the 22 patients had been having sexual intercourse.

Conclusions: Our data suggests that, patients with penile fractures undergoing delayed repair have preservation of erectile potency and overall sexual function is maintained. Anatomically, the flaccid penis lacks a fulcrum for snapping and contains relatively thick tunica albuginea, protecting it from internal rupture under strain.

In contrast, the tunica of the erect penis thins to approximately 0. Malis [5], described the first case of a penile fracture in the literature in Although initially it was believed to be a relatively rare injury, fracture of the penis has been increasingly reported. A review by Eke, identified more than cases in the world literature, with more than half of those cases originating from Islamic countries [4,6]. The largest single series to date describes cases over 9 years in a single province of Iran [4,7].

The majority of cases of fracture penis occur as the result of traumatic coitus, usually from thrusting an erect penis against the symphysis pubis or perineum [8,9]. The diagnosis of penile fracture is usually based on a good history and physical examination.

Some investigators have recommended the use of ultrasound, carvernosography and magnetic resonance imaging MRI to image and locate the site of the tunical tear before surgery [11,12]. However, the positive predictive values in these studies has been shown to be similar to that of history and clinical examination [13]. Penile fracture is a urological emergency and immediate surgical exploration with repair offers the best chance of healing with preservation of erectile function [14].

Although immediate surgical repair has been recommended by most authors, delayed repair is possible and has been suggested in situations in which accurate localization of the fracture site is clinically not evident or the patient presents late. Gross penile swelling decreases rapidly, and by days, the clot at the fracture site is easily palpable and is often visible. We report our series of patients with delayed presentation of fracture penis and managed with surgical repair. We also report the short and long term outcome in these patients. We retrospectively reviewed all medical records of patients presenting with penile fracture between January to December Twenty two patients fulfilled the inclusion criteria.

Table 1 shows detailed clinical findings of the patients. Heterosexual inter-course was the most common cause of fracture 18 patients, One patient 4. The reasons for delay is as shown in Table 2. In two cases the ultrasonography was unable to detect the site of cavernosal defect. All the fractures affected one of the two corpora and the mean size of the tear was 1.

Urethral tear was noted in one case which was confirmed on urethrogram. There was no correlation between injury extension and mechanism sexual position, etc. All the patients attended follow-up visits to the hospital at around 4 weeks, 12 weeks and at the end of 1 year. All the patients were advised to avoid active sexual intercourse for about 12 weeks. None of the 22 patients had bending of the penis. Of these 15 patients, 13 All these 13 patients reported that their erections were hard enough to achieve and maintain penetration most or all of the time.

Two These patients were using sildenafil 50 mg on a regular basis. Thirteen Patients did not complain of any bending of penis in erect and non-erect positions. The diagnosis of penile fracture is often straight forward and can be made reliably by history and physical examination. Patients usually describe a cracking or popping sound as the tunica tears, followed by pain, rapid detumescence, discoloration and swelling of the penile shaft.

If the Buck fascia remains intact, the penile hematoma remains contained between the skin and tunica, resulting in a typical eggplant deformity Figure 1. Urethral injury can occur though infrequently, hence preoperative urethrography should be considered whenever urethral injury is suspected. Kamdar et al [16], have suggested performing intraoperative flexible cystoscopy routinely just before catheter placement at the time of penile exploration. Magnetic resonance imaging MRI Figure 2 is a noninvasive and accurate means of demonstrating disruption of the tunica albuginea [17].

The increased cost, limited availability, and time requirements involved with the study have limited its routine use in assessing these injuries. However it would be reasonable to use MRI in the evaluation of patients without the typical presentation and physical findings of penile fracture. Management involves prompt exploration and surgical repair of penile fractures Figures 3,4 as reported in several contemporary publications [18].

Immediate surgical reconstruction in faster recovery, decreased morbidity, lower complication rates, and lower incidence of long-term penile curvature [18,19]. Asgari et al. Naraynsingh et al. The patient had presented with painful erection and angulation of the penis more than 3 weeks after sustaining an injury to his penis. They also believe that simple repair however delayed is associated with good outcome. Zargooshi [7] reported on the long term outcome of surgical repair in patients with a mean age of 27 years. The mean time interval between injury and presentation was 22 hours and between presentation and repair was 10 hours.

Complications occurred in eight patients 4. Mild to moderate erectile dysfunction ED was reported by eight patients. Erectile function returned within a mean range of 2 days and coitus was possible approximately 2 weeks after the repair. Nason et al. Seventeen patients were contactable. Fourteen patients demonstrated no evidence of erectile dysfunction, 1 patient reported symptoms of mild ED and one patient reported mild to moderate ED.

No patients reported insufficient erection for penetration EHGS: 1 or 2. The long-term effects of delayed presentations and the optimal timing of subsequent intervention have caused some debate. Our study demonstrates that delayed repair does not in any way affect the long term outcome in these patients. Kozacioglu and colleagues [23], reported no serious deformity or ED as a consequence of delay in surgery within a given time frame in 56 penile fractures, in terms of of hours to presentation mean of hours from trauma to repair Similarly , el-Assmy and colleagues [24], noted no difference in serious long- term complications between those who were treated surgically following an early within 24 hours or delayed up to 7 days presentation.

Erection hardness and implied erection function is one of the main determinants involved in male sexual function. The International Index of Erectile Function IIEF-5 is an abbreviated questionnaire focusing on erectile function and intercourse satisfaction for the diagnosis of the presence and severity of erectile dysfunction ED 5 questions, maximum score 25 [25].

Erection hardness is a fundamental component of erection function. It covers three functional domains sexual drive, erectile function and ejaculatory function , as well as problem assessment of these functional domains and overall satisfaction [27]. Our data too suggests that, in our cohort of penile fractures following sexual intercourse, long-term erectile potency is preserved and overall sexual function is maintained.

Reported long- term sequelae after penile fracture repair include: penile deviation, painful intercourse, painful erection, erectile dysfunction, priapism, skin necrosis, arteriovenous fistula, urethrocavernous fistula, and urethral stricture [6]. In our small series of men with penile fracture managed within a short time frame after presentation, erectile potency is maintained and long-term overall sexual satisfaction is promising irrespective of the time of surgical repair.

Order for reprints. Toggle . ISSN: Author and article information. DOI : Open J Trauma 1 2 : DOI: Main article text. Table 1 : Patients Characteristics. AGE: Time duration between injury and presentation: Time duration between presentation and surgical intervention: 4. J Urol J Trauma Z Urol Nephrol

Penile fracture gif

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