Blunt penile trauma

Basta AM, Blackmore CC, Wessells H (2007) Predicting urethral injury from pelvic fracture patterns in male patients with blunt trauma. J Urol 177 571-575 Bertolotto M, Calderan L, Cova MA (2005) Imaging of penile traumas-therapeutic implications. Eur Radiol 15 2475-2482... 

Occasionally, cavernosal tissue injury from a blunt perineal trauma can result in a fibrotic scar encompassing the entire circumference of a corpus cavernosum. Ultrasound shows a hyperechogenic stripe with acoustic shadow dividing the corpus in two portions. The cavernosal artery can be obliterated or warped at the level of the scar (Fig. 18.3). Since the penile septum is usually nearly complete at the base of the penis, the proximal portion of the injured corpus remains hemodinamically isolated from the other portions (Horger et al. 2005). 

Vascular pathology may involve lesions of the inflow or outflow mechanisms of penile erection. Erectile dysfunction may be a manifestation of generalized atherosclerosis and may even be its initial presentation. Common risk factors associated with generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation (Rosen et al. 1991). Less commonly, local stenosis of the conunon penile artery may occur in men who have sustained blunt pelvic or perineal trauma (Levine et al. 1990). 

As described in Chapter 9, priapism is an uncommon medical condition defined as persistent tumescence or erection not associated with sexual desire or stimulation (Pautler and Brock 2001). Different pathophysiologies have been described. Low-flow or ischemic priapism is characterized by complete painful erection secondary to inadequate venous outflow leading to hypoxia, acidosis and pain (Lue et al. 1986 Pautler and Brock 2001). High-flow priapism is usually associated with penile or perineal blunt trauma and cavernosal artery tear (Pautler and Brock 2001). Patients... 

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