Am Fam Physician. 2020 Dec 15;102(12):751-752.
A 34-year-old patient presented with penile pain and swelling that had been present for several hours following insertive anal intercourse. The patient had no history of pain associated with erection or intercourse before the onset of swelling.
On physical examination, his vital signs were normal, and he appeared well. Swelling and ecchymosis were present along the dorsal shaft of the penis (Figure 1). The patient was able to void spontaneously, and there was no hematuria.
Based on the patient's history and physical examination findings, which one of the following is the most appropriate next step?
A. Bedside incision and drainage of the area.
B. Corporal aspiration with subsequent irrigation using phenylephrine.
C. Ice application and supportive management of the affected area, with outpatient follow-up.
D. Immediate urologic evaluation.
E. Manual compression to reduce the foreskin distally over the glans penis.
The answer is D: immediate urologic evaluation. Acute penile fracture may present in a dramatic way. The most common mode of injury is sexual intercourse, but it can also be caused by masturbation or rolling over in bed.1 The injury involves acute tear or rupture of the tunica albuginea of the corpus cavernosum. This patient has the classic physical examination finding of penile fracture, which is described as an “eggplant deformity” and results from hematoma in the penile shaft and associated discoloration of penile skin.2
Imaging is typically reserved for when there is diagnostic uncertainty.2 Management of penile fracture involves operative repair of the damaged tunica albuginea.3 Immediate operative repair is generally recommended over delayed treatment.4 Long-term complications may include erectile dysfunction, penile deformity, or voiding
Referencesshow all references
1. Agarwal MM, Singh SK, Sharma DK, et al. Fracture of the penis: a radiological or clinical diagnosis? A case series and literature review. Can J Urol. 2009;16(2):4568–4575....
2. Morey AF, Metro MJ, Carney KJ, et al. Consensus on genitourinary trauma: external genitalia. BJU Int. 2004;94(4):507–515.
3. Gamal WM, Osman MM, Hammady A, et al. Penile fracture: long-term results of surgical and conservative management. J Trauma. 2011;71(2):491–493.
4. Swanson DE, Polackwich AS, Helfand BT, et al. Penile fracture: outcomes of early surgical intervention. Urology. 2014;84(5):1117–1121.
5. Hatzichristodoulou G, Dorstewitz A, Gschwend JE, et al. Surgical management of penile fracture and long-term outcome on erectile function and voiding. J Sex Med. 2013;10(5):1424–1430.
6. Manjunath AS, Hofer MD. Urologic emergencies. Med Clin North Am. 2018;102(2):373–385.
7. Burnett AL, Bivalacqua TJ. Priapism: current principles and practice. Urol Clin North Am. 2007;34(4):631–642.
This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.
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