Penile hematoma

Adverse effects of this procedure have been reported (1) ecchymosis (37%), discomfort (28%), hematoma (10%), numbness (6.9%), penile skin irritation, and edema. Subcutaneous penile hematoma occurred in two patients using anticoagulants and penile gangrene occurred in one patient all had worn the constriction band overnight (2). The current recommendation is to apply the constriction band for not more than 30 minutes. 

Trauma to the perineum, penis or groin, while usually resulting in high-flow priapism, can result in venous compression secondary to penile hematoma or edema. 

Direct traumas to the genitalia may result in blood extravasation within the subepithelial connective tissue or in the space between the Colles and the Buck s fascia. Location of the penile hematomas can be evaluated with ultrasonography (Fig. 12.3). In fact, as illustrated in Chapter 11, penile hematomas present clinically with a different appearance when they are restricted below the Buck s fascia or when they spread in the more superficial layers. Ultrasonography, however, allows evaluation of the relationships between the penile envelops and the... 

Fig. 12.3a-c. Axial scans. Relationship between penile hematomas ( ) and the intact tunica albuginea, a Hematoma spreading outside the Buck s fascia (arrowheads), b Hematoma between the tunica albuginea (open arrow) and the Buck s fascia (arrowhead), c Hematoma within the left corpus cavernosum... 

The most common complication of this procedure is loss of penile length. This complication does not predude most men from having sexual intercourse. Other complications reported include erectile dysfunction, penile hematoma, penile narrowing, and urethral injury (Ralph et al. 1995). 

As occurs in surgical procedures elsewhere, penile hematoma, other postoperative fluid collections and infection are the most common complications of penile surgery. In the course of time, hematomas present with different ultrasound features (Doubilet et al. 1991). Acutely, their content can appear echogenic then, they become hypoechoic and organize presenting with complex echogenic areas, anechoic regions and septations. Lymphatic and serous collections are uncommon and usually appear anechoic. 

Penile pain Penile pain after intracavernosal administration was reported. In the majority of the cases, penile pain was rated mild or moderate in intensity. Hematoma/Ecchymosis In most cases, hematoma/ecchymosis was judged to be a complication of a faulty injection technique. 

Intracavernosal (4%-l%) Penile pain (37%), prolonged erection, hypertension, localized pain, penile fibrosis, injection site hematoma or ecchymosis, headache, respiratory infection, flu-like symptoms... 

As regards penile imaging, extended-field acquisition can be useful especially to depict anatomical variations, in trauma patients to depict large hematomas and in patients with severe Peyronie s disease to improve evaluation of plaque extension and provide the urologist with a panoramic view of the al-bugineal involvement. 

Fig. 10.3a,b. Grey-scale appearance of the penile shaft after successful angiographic embolization of a right cavernosal artery tear, a Axial scan obtained 1 h after embolization shows a cavernous hematoma ( ) in the site of the embolized fistula within the right corpus cavernosum. A smaller hematoma (open arrow) not associated to cavernosal artery injury is recognized within the left corpus cavernosum as well, b Axial scan obtained 6 months later shows that the echotexture of the corpora cavernosa in the site of the previously embolized fistula is inhomogeneous due to fibrous changes. The patient, however, reported normal erections... 

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...

This lesion can occur when the erect penis is forcibly displaced towards the feet (Pryor and Hill 1979). Diagnosis of rupture of the suspensory ligament is made by history and by palpation of a gap between the base of the shaft of the penis and the symphysis pubis. An abnormal angle is noted during erection. Ultrasonography is able to document the gap between the pubis and the penile shaft and associated hematomas of the soft tissues (Fig. 12.5), but usually does not provide additional useful information (Bertolotto and Pozzi Mucelli 2004). 

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...

Recently it has been reported that injury to the erect penis may produce isolated disruption of the penile septum. Ultrasound evaluation allows early identification of the resulting hematoma (Fig. 12.10), which can be recognized as a well-defined cystic-like area in the septal region (Brant et al. 2007). Hematoma... 

Most of patients with circumscribed cavernosal fibrosis or scar have had penile surgery or traumas. Postraumatic fibrosis usually results from healing of intracavernosal hematoma (Bertolotto and Pozzi Mucelli 2004 Munarriz et al. 2005) or rupture of the tunica albuginea from sudden bending of the erect penis. A recent report (Brant et al. 2007) describes a subset of patients with penile induration who were found to have only a circumscribed septal fibrotic change on penile ultrasonography. About 36% of these patients had a significant history of penile trauma. 

Because of its length, the male urethra is vulnerable to traumatic lesions that may cause acute urinary retention and sudden onset of urethrorrhagia and even late stenosis. Urethral trauma can be divided into external trauma, either contusive or penetrative, and internal or endourethral trauma. Internal traumas usually follow iatrogenic maneuvers. External traumas are frequent events and can occur in the penile urethra as a result of road or work accidents, sporting activities or sex. The urethra can be compressed by subcutaneous or intraspongiosal hematomas and may present complete or incomplete mucosal interruption. 

---