Delayed approach of a penile fracture with encapsulated hematoma.

Penile fracture (PF) is defined as the rupture of the tunica albuginea (TA) of the corpora cavernosa (CC) caused by trauma to the erect penis. We present a case and clinical evolution of the delayed approach of PF. Physical examination showed a ventral rounded mass in the middle surface of the penile shaft, associated with mild discoloration and edema. Surgery was performed with a vertical penoscrotal incision. We found an encapsulated hematoma on the right ventral mid penile shaft connected at its base to an approximate 1 cm transverse defect on the TA and we performed debridement and excision of the hematoma. Tunical defect was repaired with PDS 3/0 simple suture. The patient had a great postoperative evolution without local complications. The early diagnosis and surgical treatment reaches better functional results, with maintenance of erectile function in patients with penile fracture.

Effect of dexpanthenol on wound healing in penile fracture model: An experimental study.

OBJECTIVES: In the present study, we aimed to investigate the effect of dexpanthenol on wound healing at the histopathological level on cavernous tissue. MATERIALS AND METHODS: Forty-four Wistar albino rats weighing 220-250 g were used. The rats were randomly divided into four groups as Group B, Group S, Group LD, and Group SD. In Group B, the incision was not repaired and left to secondary healing. In Group S, the incision line was repaired with 5/0 polyglactin suture. In Group LD, 0.25 mg/kg dexpanthenol was applied subcutaneously below the repaired wound region once a day during 14 days. In Group SD, 500 mg dexpanthenol was applied intraperitoneally once a day during 14 days. RESULTS: No fibrosis was observed in 8 (80%) rats in group SD. Fibrosis rates were significantly lower in Group SD compared to Group B, Group S, and Group LD (p = 0.013, p = 0.005, and p = 0.003, respectively). CONCLUSION: Systemic dexpanthenol administration significantly decreased fibrosis in penile fracture model on rats.

OBJETIVO: En el estudio actual nuestro objetivo fue investigar el efecto del dexpantenol en la cicatrización de heridas a nivel histopatológico en el tejido cavernoso. MÉTODOS: se utilizaron 44 ratas Wistar albinas con un peso de 220-250 g. Las ratas se dividieron aleatoriamente en 4 grupos como grupo B, grupo S, grupo LD y grupo SD. En el grupo B, la incisión no se reparó y se dejó para la cicatrización secundaria. En el grupo S, la línea de incisión se reparó con sutura de poliglactina 5/0. En el grupo LD, se aplicaron 0.25 mg/kg de dexpentanol por vía subcutánea debajo de la región de la herida reparada una vez al día durante 14 días. En el grupo SD se aplicaron 500 mg de dexpentanol por vía intraperitoneal una vez al día durante 14 días. RESULTADOS: No se observó fibrosis en 8 (80%) ratas del grupo SD. Las tasas de fibrosis fueron significativamente más bajas en el grupo SD en comparación con el grupo B, el grupo S y el grupo LD (todos p < 0.05). CONCLUSIÓN: La administración sistémica de dexpantenol disminuyó significativamente la fibrosis en el modelo de fractura de pene en ratas.

Primary urethral reconstruction results in penile fracture.

Objective This study assessed primary urethral reconstruction results in patients with a penile fracture. Materials and methods Between January 2005 and April 2016, patients who underwent primary urethral reconstruction due to penile fracture were called for a follow-up. Epidemiological and clinical presentation data and operative findings were reviewed retrospectively. Partial urethral lesions were primarily treated with interrupted absorbable sutures over urethral catheter. In cases of complete urethral lesion, tension-free end-to-end anastomosis was performed. From the third month after surgery, all patients were interviewed using the International Prostate Symptom Score questionnaire and uroflowmetry. Retrograde urethrocystography was used in patients with urinary symptoms or altered uroflowmetry to rule out or confirm urethral stenosis. Results Of 175 patients with penile fractures, 27 (15.4%) had associated urethral injury. All patients were diagnosed with penile fracture by means of clinical history and physical examination. No subsequent examinations were conducted. Ages varied from 30 years to 58 years old (mean 39.2 years). All fractures resulted from sexual activity. Reported sexual positions were 'doggy style' position in eight cases (61.5%) and with the 'man on top' in five cases (38.4%). Ten patients (76.9%) experienced haematuria, ten (76.9%) had urethral bleeding and four (30.7%) suffered urinary retention. Unilateral and bilateral injury of the corpus cavernosum was observed in four (30.7%) and nine (69.2%) patients, respectively; partial injury was found in nine cases (69.3%) and complete urethral injury was noticed in four cases (30.7%). All cases of complete urethral injury were associated with bilateral lesion of the corpus cavernosum. Six patients who had uroflowmetry with maximum urinary flow rate below 15 ml/s and/or had IPSS above 7 underwent retrograde urethrocystogram, and this was normal in all cases, excluding the possibility of urethral stenosis. Two patients (15.3%) experienced surgical postoperative complications represented by an urethrocutaneous fistula and a subcutaneous abscess adjacent to the end-to-end anastomosis area. Conclusions Penile fracture is a rare urological emergency, especially when it is associated with a urethral lesion. This must be suspected when the clinical picture is suggestive or in cases of high-energy trauma, especially in bilateral lesions of the corpus cavernosum. Complementary imaging methods are not needed in these cases and immediate exploration should not be delayed. Primary urethroplasty produces satisfactory results with low complication levels. Nonetheless, prospective studies with larger samples should be conducted.

A delayed foreskin-sparing approach to the management of penile fractures in uncircumcised Jamaican men.

INTRODUCTION: The traditional surgical approach to penile fracture is to perform a circumferential subcoronal degloving incision emergently to repair the injury. This approach necessitates circumcision to avoid foreskin complications. We present four men who had a delayed foreskin-sparing approach and discuss its advantages. PRESENTATION OF CASE: Four of five uncircumcised patients who had suspected penile fractures secondary to coital injury, and without suspicion of concomitant urethral injury, had a delayed exploration, seven days after injury, utilizing an incision directly over the palpable haematoma, at the location of the tunical defect, thereby resulting in foreskin preservation. Two of 5 patients had repair under general anaesthesia, one under local anaesthesia and surgery was cancelled in another because upon reassessment at seven days he had normal erections and a normal penile examination. At follow up, all men had good functional and cosmetic outcomes. DISCUSSION: Uncircumcised patients with penile fractures, without suspicion of urethral injury, may undergo a delayed repair without prophylactic circumcision since there is minimal risk of foreskin complications. Delayed repair decreases the incidence of negative explorations by fostering a conservative approach in mimicking conditions such as superficial vein lacerations. It also enables the use of local anaesthesia in an elective ambulatory setting. CONCLUSION: Delayed repair of penile fractures results in foreskin preservation, facilitates elective ambulatory care under local anaesthesia and decreases the incidence of negative surgical explorations.

Fracturas del pene / Penile fracture

Background: Penile fracture occurs when the erect penis is bent suddenly and forcefully, rupturing the tunica albuginea of one or both of the corpus cavernosum. A delay in its treatment may lead to functional and morphological sequelae. Case reports: We report five patients aged 26 to 44 years with penile fracture and right corpus cavernosum involvement. All patients excepting one had felt pain. An emergency ultrasound was done in three cases to confirm the diagnosis and the extension of the lesion. All were operated, had an uneventful postoperative period and are currently asymptomatic.

Introducción: La fractura del cuerpo cavernoso representa una urgencia urológica infrecuente pero grave, ya que la lesión de estructuras cercanas y una demora en su tratamiento suele generar complicaciones morfológicas y funcionales irreversibles. Casos clínicos: Registramos 5 casos de fractura peneana en nuestro hospital en el período 2008-2012, con afectación del cuerpo cavernoso derecho y hematoma asociado en todos ellos. La edad promedio fue de 33,5 (rango 26-44) años. Todos relataron los síntomas característicos excepto uno, que permaneció sin dolor. Se realizó una ecografía urgente en 3 casos para confirmar el diagnóstico y evaluar la extensión de la lesión. Los pacientes fueron intervenidos quirúrgicamente de urgencia, el postoperatorio transcurrió sin incidencias y actualmente todos se encuentran asintomáticos.