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ORIGINAL ARTICLE J. Med. Sci. (Peshawar, Print) October 2011, Vol. 19, No.

4: 189-191

CLINICAL DIAGNOSIS OF PENILE FRACTURE


Siddique Ahmad, Ziaul Haq, Mazhar Khan
Department of Surgery, Hayatabad Medical Complex, Peshawar - Pakistan

ABSTRACT
Objective: To determine the accuracy of clinical diagnosis in penile fracture.
Material and Methods: This descriptive study was conducted in the Surgical Unit, Hayatabad Medical Complex,
Peshawar from January 2007 to December 2009. All patients presenting with blunt penile trauma were included in the
study. Patients age, activity leading to injury, symptoms and signs were recorded. Diagnosis was made clinically and
confirmed with operative findings.
Results: Total number of 39 patients was included. Age range was 21 to 49 years with a mean age of 28 years 4SD.
The commonest cause of fracture was sexual trauma in 41.03% of the cases. Clinical diagnosis as penile fracture was
correct in 100% of cases, while in 97.43%, the side of rupture i.e. right or left, was also correctly determined
pre-operatively. The site of fracture i.e. proximal, middle and distal penile was correctly diagnosed in 79.48% of the
patients pre operatively. Complete recovery took place in all the patients following immediate surgical repair. On six
month followup only 5 patients complained of mild pain during erection and 3 had slight curvature of the penis, which
did not hamper sexual function.
Conclusion: Clinical diagnosis of penile fracture is easy and accurate. No further investigations are required.
Key Words: Fracture, Penile, Corpora cavernosa, Clinical, diagnosis.
Words:

INTRODUCTION diagnose the site and extent of injury, but these should
not replace clinical assessment or delay exploration.
Penile fracture is a rupture of tunica albugenia If there is haematuria, voiding difficulty or urinalysis
of one or both corpora cavernosa following injury to reveals blood, retrograde urethrogram should be
an erect penis. This typically occurs when the engorged performed 12. Cavernosography is a useful test in
corpora cavernosa are forced to buckle under doubtful cases. It is invasive with low sensitivity and
pressure by blunt trauma1. The first case of penile there is a risk of contrast reaction, post procedure
fracture was reported in 19252,3. The condition was priapism and corporal fibrosis13. Penile ultrasound is a
initially regarded as a relatively rare entity, but is readily available, non invasive investigation but is highly
increasingly reported as a genitourinary trauma. A operator dependent with low sensitivity14. Magnetic
review by one investigator identified 1331 cases in 183 Resosnance Imaging (MRI) is a useful investigation that
publications between January 1935 and July 2001. pinpoints the site and extent of tunica rupture but is
Interestingly, more than half of these cases are reported expensive and not readily available, especially in the
from Muslim countries4. In the overwhelming majority emergency setup15. The aim of this study was to
of cases the etiology is sexual, with coitus and evaluate the accuracy of clinical diagnosis in blunt
masturbation being the most common causes5,6,7. penile fracture so that unnecessary delay in surgical
Some authors have described female superior repair is avoided, preventing long term complications.
position being a frequent cause of sustaining penile
fracture, possibly due to abnormal angulations of the MATERIAL AND METHODS
MATERIAL
erect penis when pushed against the female perineum
This descriptive study was conducted in the
or symphysis pubis8,9.
Surgical Unit, Hayatabad Medical Complex, Peshawar
Diagnosis of penile fracture is mainly clinical and from January 2007 to December 2009. All the patients
treatment is immediate surgical repair to avoid presenting with blunt penile trauma were included in
complications10,11. Several investigations are used to the study. Patients not willing to participate in the study
or treated elsewhere were excluded from the study.
Address for Correspondence: Diagnosis was made based on history and clinical
Dr
Dr.. Siddique Ahmad examination and confirmed with operative findings. No
Senior Registrar investigation was done for diagnosis. Surgical repair
Department of Surgery,
was performed within 24 hours of presentation using
Hayatabad, Medical Complex, Peshawar - Pakistan
sub coronal circumferential penile incision and de
Cell: 0345-9415719
Email: ahmadsurg@gmail.com gloving the penis. Repair was done with vicryl 3/0

J. Med. Sci. (Peshawar


eshawar,, Print) October 2011, V
(Peshawar ol. 19, No. 4
Vol. 189
suture under local anaesthesia. Patients were followed Due to these typical presentations, the diagnosis
up for six months. is mainly clinical. Radiological investigations are
expensive, time consuming and rely on the experience
RESULTS
RESULTS of the radiologist17. Most of the studies on this subject
show a limited role of investigations, apart from history
The total number of patients was 39 with an age
and clinical examination to diagnose penile fracture.
range of 21-49 years (mean 28 years 4 SD). Sexual
Preoperative cavernosography, ultrasound and MRI is
intercourse was commonest cause of fracture (41.03%)
recommended to diagnose and determine the site of
and rest of causes are shown in Table 1. The number
fracture i.e. proximal, middle or distal shaft. Retrograde
of married patients was 28, and unmarried 9. Clinical
urethrogram is necessary for suspected associated
diagnosis as penile fracture was accurate in 100% of
urethral injury 18. Cavernosography is an invasive
cases. Side of fracture i.e. right or left was clinically
procedure with a risk of contrast reaction and post
diagnosed accurately in 97.43% while site of fracture
procedural priapism. MRI is expensive and less readily
i.e. proximal, middle and distal penile fracture in
available. Likewise ultrasound is less sensitive and
79.48% of cases shown in Table 2. Only 3 patients
technically difficult in the presence of heamatoma.
developed wound infection post operatively which was
Secondly all these investigations lead to unnecessary
treated conservatively. On six months follow up, 5
delay in the immediate repair of fracture which is
patients complained of mild pain and 2 had slight
required for an excellent outcome19. Leandro et al
curvature of penis during erection which did not
presented 56 cases and had performed ultrasound in 2
hamper sexual activity.
cases; MRI in 1 case, retrograde urethrogram in 7
Table 1: Causes of Penile F
Penile racture
Fracture cases20. Ahmad Abolyosr had used MRI in all 14 cases
to determine the site of fracture as he had used the
Causes No. and percentage localized longitudinal penile incision to repair the
Sexual intercourse 16 (41.03) fracture21.
Masturbation 10 (25.64) In our study the clinical diagnosis of penile
Manipulation 7 (18.0) fracture was correct in 100% cases, while in 97.43%
the side of fracture and in 79.48%, the site was also
During sleep 4 (10.25) correctly diagnosed clinically. This shows that clinical
Fall on erect penis 2 (5.12) diagnosis of penile fracture is easy and accurate. MRI
and caverno-sography are used for determination of
Total 39 (100)
side and site of fracture, which is not relevant when a
circumferential penile incision is used and de gloving
Table 2: Clinical diagnosis of penile fracture
the penis, which exposes all the sides and sites of
Side Site penile shaft. All the patients were explored within 24
hours of admission. Two patients had wound infection
Right Left Proxi- Middle Distal in the immediate post operative period which was
mal treated conservatively. Long term results were
satisfactory with normal sexual activity. Only 5 patients
Clinical 25 14 23 3 13
complained of pain while 3 had slight curvature of
diagnosis
penis during erection.
Operative 26 13 27 2 10
diagnosis
CONCLUSION
CONCLUSION
Diagnosis of penile fracture is essentially
Total percent 97.43% 79.48%
clinical and no further investigations are required.
P value 0.812 0.634
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J. Med. Sci. (Peshawar


eshawar,, Print) October 2011, V
(Peshawar ol. 19, No. 4
Vol. 191