However, in cases of tunica albuginea rupture, it is better to explore surgically and repair the tunica, to reduce the chances of fibrous plaque formation or angulated penis 1. If there is no tunica albuginea rupture, the injury can be managed non-operatively with cold compresses and simple analgesia 7. Urethral rupture or post-traumatic stricture can be depicted by this imaging. This invasive interventional procedure is often avoided but may depict the tear in corpora cavernosa. It can also accurately depict the depth and extent of the tear. MRI can accurately determine if the fracture is transversely or longitudinally oriented. A tear can be seen as T2 hyperintense breach. Tunica albuginea is a hypointense band on all sequences. An associated collection or hematoma may also be seen alongside the breach. A hypoechoic breach in this band of fibrous tissue may be seen especially along the penile longitudinal axis. The tunica albuginea is usually seen as a hyperechoic linear band in the penis covering the corpora cavernosa and the corpus spongiosum. A retrograde urethrogram may be of use in the post-operative period particularly if there is urethral involvement. MRI of the penis is the most useful study to determine the extent of injury. Radiographic featuresĮmergency ultrasound is usually the initial imaging modality, but because the penis is often markedly swollen and painful, it may not be worthwhile. 5 proposed an ultrasound-based grading system of penile rupture that is helpful in defining the extent of the injury. a more common etiology in Middle Eastern populationsįractures usually occur in distal two-thirds of the penis 1, and is usually unilateral, being more common on the right 7.the practice of 'taqaandan': manually bending the erect penis to achieve detumescence.non-sexual trauma involving an erect penis (e.g.during vaginal sexual intercourse is most common cause in Western populations.sexual intercourse: generally occurs when the erect penis hits against the perineum or pubic symphysis.In the West, it is assumed that most penile rupture is due to trauma during sex, however in the Middle East, taqaandan is not uncommon 7: However, urethral injury is associated only with a very severe injury. The corpora cavernosa is injured as soon as tunica albuginea is breached. Pathologyĭuring an erection the tunica albuginea thins and thus it is susceptible to mechanical injury. Additionally, gross evidence of urethral injury may also be present, such as blood at the meatus, hematuria, or difficulty voiding 8. The characteristic bruising and swelling that develops has been described as the 'eggplant' or ' aubergine' deformity or sign 7,8. Neither serious deformities nor erectile dysfunction occur as a consequence of a delay in surgery in the long term in patients with no urethral involvement within a given period of time.Patients typically have a characteristic history of trauma in an erect penis: a 'crack' may be heard with associated severe pain, loss of erection (detumescence) and a suddenly swollen penis 7,8. Surgical repair has a good functional outcome and low complication rates in the long term. The results of the IIEF questionnaires of each group for time periods and for individual patients in each separate group were statistically similar. There was no statistically significant difference between the 3 groups in terms of age and length of tears. The mean number of hours from trauma to surgery was 11.3 ± 8.5. Overall, the mean follow-up was 46.1 ± 19.2 months. An erectile dysfunction score was calculated for every patient. We applied the validated Turkish version of the International Index of Erectile Function (IIEF) questionnaire 3 times: for the time period before the fracture, 1 year after the fracture, and at the time of the study. We evaluated 43 patients sorted into 3 groups according to the time interval until surgery. We investigated whether a delay in time until surgery, in terms of hours, has any effect on the overall long-term results of surgical repair of penile fractures.īetween 20, we operated on 56 patients with penile fractures.
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