Penile fracture

Peyronie s disease may be associated with other flbrotic disorders such as Dupuytren s contracture or Lederhosen syndrome. Its association with vascular comorbidities is controversial (Kadioglu et al. 2002 Mulhall et al. 2004 Usta et al. 2004), as is the role of overt trauma such as penile fracture (Zargooshi 2004). 

Weidner W, Hauck EW, Schnitker J (2005) Potassium para-aminobenzoate (POTABA) in the treatment of Peyronie s disease a prospective, placebo-controlled, randomized study. Eur Urol 47 530-535 discussion 535-536 Zargooshi J (2004) Trauma as the cause of Peyronie s disease penile fracture as a model of trauma. J Urol 172 186-188... 

Patients with penile fracture may present with associated injury to the corpus spongiosum and to the anterior urethra. The severity of the lesions can be variable, ranging from urethral contusion to partial or complete rupture. 

Fig. 11.1. Penile fracture with rupture of the Buck s fascia. The hematoma spreads to the attachment of the Colles fascia involving the penis, scrotum and perineum with typical butterfly configuration...

Fig. 11.2. Penile fracture with intact Buck s fascia. The hematoma is confined to the shaft...

Heymann AD, Bell-Thompson J, Rathod DM, Heller LE (1977) Successful reimplantation of the penis using mi-crovascular techniques. J Urol 118 879-880 JackGS, Garraway I, Reznichek R, Rajfer J (2004) Current treatment options for penile fractures. Rev Urol 6 114-120... 

Kulovac B, Aganovic D, Junuzovic D et al (2007) Surgical treatment and complications of penile fractures. Bosn J Basic Med Sci 7 37-39... 

Tsang T, Demby AM (1992) Penile fracture with urethral injury. J Urol 147 466-468... 

Since the penis is mobile and largely protected by its position, it is much less frequently injured than other parts of the body. As mentioned in Chapter 11, however, it can be wounded as a result of various accidents, and in the erect state it is more prone to trauma in the form of penile fracture. Distinction between penetrating and non-penetrating penile... 

A variety of injuries to extraalbugineal vessels can occur during intercourse mimicking penile fracture (Nehru-Babu et al. 1999 Armenakas et al. 2001). Deformation and immediate penile detumescence, however, do not occur following isolated vascular injury to the penis because the tunica albuginea is intact. When identified, these lesions can be treated conservatively. 

Fig. 12.6. Penile fracture. Axial scan showing a large albu-gineal tear (open arrows) as interruption of the thin echo-genic line of the tunica albuginea (arrowheads) of the right corpus cavernosum. Associated extraalbugineal hematoma ( ) is also recognized...

In patients with penile fracture, imaging is used to confirm the diagnosis when clinical presentation is atypical, or when severe local pain and swelling prohibit a thorough physical examination. Ultrasonography is able to detect the exact site of the tear as an interruption of the thin echogenic line of the tunica albuginea (Fig. 12.6), determine whether... 

In patients with penile fracture, injury can occasionally involve the cavernosal tissue deeply, and associated cavernosal artery tear can be detected at color Doppler ultrasound (Fig. 12.7). High-flow priapism, however, does not develop in these patients, probably because of blood leakage from the albugineal tear. In our experience no attempt should be made during the operation to repair the arterial... 

Armenakas NA, Hochberg DA, Fracchia JA (2001) Traumatic avulsion of the dorsal penile artery mimicking a penile fracture. J Urol 166 619... 

Cavalcanti AG, Krambeck R, Araujo A et al (2006) Penile lesion from gunshot wound a 43-case experience. Int Braz J Urol 32 56-60 discussion 60-53 Choi MH, Kim B, Ryu JA et al (2000) MR imaging of acute penile fracture. Radiographics 20 1397-1405 El-Bahnasawy MS, Gomha MA (2000) Penile fractures the successful outcome of immediate surgical intervention. Int JImpot Res 12 273-277... 

Fedel M, Venz S, Andreessen R et al (1996) The value of magnetic resonance imaging in the diagnosis of suspected penile fracture with atypical clinical findings. J Urol 155 1924-1927... 

Mydlo JH, Hayyeri M, Macchia RJ (1998) Urethrography and cavernosography imaging in a small series of penile fractures a comparison with surgical findings. Urology 51 616-619... 

Fig. 18.8. Posttraumatic penile deformation following untreated penile fracture. Color Doppler US shows venous leak at the level of the scar due to incomplete distension of the erectile tissue...

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