Penile fracture: role of early surgical intervention on postoperative outcome

Fracture of penis is relatively uncommon but grave urological emergency, which needs urgent surgical intervention to achieve good postoperative outcome

Objective: To determine the outcome of early surgical repair in patients presenting with fracture of penis

Patients and Methods: This retrospective study comprises 13 patients with fracture of penis, presenting in emergency of Services Hospital, Lahore from 2000-2007. Diagnosis was made clinically. No radiological investigation was carried out. All patients had primary suturing of the tunica tear and were followed up for 2-6 months postoperatively

Results: Mean time interval between accident and arrival to hospital was recorded. Eight patients [61.5%] had fracture due to sexual intercourse. Three patients [23.08%] bending of penis. Masturbation and fall on to an erect penis each accounted for 1 [7.70%] of the total cases. There were no significant complications except necrosis of penile skin in one patient. Erectile function was preserved in all patients postoperatively

Conclusion: Early surgical intervention for penile fracture has good postoperative outcome with acceptable complication rate. Early diagnosis and surgical repair are instrumental in ensuring good outcome and minimal complications

Fournier gangrene following iatrogenic urethral trauma

To assess outcome of 17 patients with Fournier gangrene due to iatrogenic urethral trauma after aggressive treatment. Record of patients with Fournier gangrene due to iatrogenic urethral trauma was reviewed retrospectively between Jan 2000 to Dec 2007 in Department of Urology Services Hospital, Lahore. Etiology, duration of injury, extent of involvement, management, hospital stay and course of rehabilitation were evaluated. Seventeen patients were identified. Mean age of the patients was 43.5 years. Mode of urethral injury included traumatic catheterization [9 cases], traumatic bougienage [6 cases] and urological endoscopy [2 cases]. Mean time interval between injury and presentation in the hospital was 7.14 days [range 1-30 days]. All patients were treated with broad spectrum antibiotics, suprapubic cystostomy and multiple sessions of debridement [mean 3.07]. Mean hospital stay was 21.3 days and mean time taken for rehabilitation of urethra and skin cover was 16.5 weeks. Optical urethrotomy was required in 11 patients, end to end urethral anastomosis in four and perineal urethrostomy in one patient. Bilateral orchiectomy was done in two and penectomy in one patient. Five patients required skin grafting. Urethral trauma due to transurethral manipulations may lead to Fournier gangrene. Patients usually present late in our set up. Multidisciplinary approach towards management including aggressive repeated sessions of debridement can improve survival. Rehabilitation takes a long course. Measures should be taken to prevent iatrogenic urethral injury