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03-02-2011, 07:58 AM
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Fractured Penis During Sexual Intercourse
Fractured Penis During Sexual Intercourse In A 38 Years Old Male 38 yrs old male (from India) presented with severe excruciating pain over the penis and immediate loss of erection, following a cracking noise in the penis while having intercourse with his wife previous night. Patient denied use of sildenafil (Viagra) or artificial tumescence device before intercourse. On examination penis was grossly enlarged and tender with ecchymoses over suprapubic region and scrotum (See Figure 1). Patient could pass the urine effortlessly. He gave history of religious circumcision at the age of two years. Depending on significant history and gross external examination, diagnosis of fracture penis was made and need of cavernography is obviated. Under spinal anesthesia and gauze tourniquet applied at the root of penis, a circular incision was kept over the shaft of penis, 5 mm proximal to corona glandis. The incision deepened and Bucks fascia was cut in circular manner as that of skin. (See Figure 2) About 20 ml of organized hematoma was evacuated and penis was degloved till its root. A tear of 4mm in the tunica albuginea was found at the base of right corpora cavernosa. (See Figure 3) The edges of the defect in the tunica were freshened. A watertight closure was achieved by interrupted sutures in inverted manner so that knots will not be palpable. (See Figure 4) We preferred absorbable suture vicryl 3-0 for this purpose. Hemostasis was achieved and checked again. Opposite corpus cavernosum was found essentially normal. Bucks fascia was repaired and skin was approximated with Nylon 3-0 suture. Patient was given broad spectrum antibiotics, anti-inflammatory drug along with diazepam which helped in alleviating the spontaneous erections. Elevation to the penis was given with the help of tongue depressor for two postoperative days. Patient showed significant improvement with decreased swelling and ecchymoses, within 4 days. Sutures were removed on 7th day and patient was discharged. Examination after 1 month showed painless erection of penis without any apparent deviation. Abstract Fracture of the penis occurs due to the rupture of the tunica albuginea of the corpus cavernosum. The usual cause is abrupt bending of the erect penis by blunt trauma most commonly during sexual intercourse. Obvious clinical findings may preclude the need of cavernosogram. Early surgical management is the treatment of choice with low incidence of complications. |