questions 1

Penile Fracture

Topic updated on 08/29/17 7:18pm

Snapshot
  • A 28-year-old man presents to the emergency department with penile pain after hearing a "popping" sound during sexual intercourse. On physical exam the penis is tender to palpation, s-shaped, and there is swelling and ecchymosis. Urology is immediately consulted.
Introduction
  • Clinical definition
    • traumatic rupture of the corpus cavernosum
      • considered a urologic emergency
  • Epidemiology
    • incidence
      • rare
  • Etiology
    • typically secondary to sexual intercourse
  • Pathogenesis
    • damage to the tunica albuginea occurs when the erect penis is subjected to blunt trauma or abrupt bending
Presentation
  • History
    • hearing a "popping" or "snapping" sound at the time of injury (often during intercourse) of the erect penis
  • Symptoms
    • pain
  • Physical exam
    • "eggplant deformity"
      • penile deformity with swelling and ecchymosis
        • abnormally curved penis ("s-shaped")
    • tenderness to palpation
Imaging
  • Diagnostic cavernosography
    • indication
      • when the diagnosis is equivocal
  • Magentic resonance imaging (MRI)
    • indication
      • when the diagnosis is equivocal
Studies
  • Diagnostic criteria
    • this is generally a clinical diagnosis based on history and physical exam
Differential
  • Penile amputation
  • Penetrating injury to the penis
  • Penile soft tissue injury
    • e.g., infections and burns
Treatment
  • Operative
    • surgical repair
      • indication
        • penile fracture is considered the treatment option for penile fracture
Complications
  • Complications
    • erectile dysfunction
    • penile deformity
    • urethral injury
    • damage to corpus cavernosum


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Qbank (1 Questions)

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(M2.RL.47) A 21-year-old man presents to the emergency room in distress. He reports that during sexual intercourse, he heard a cracking sound. He immediately noticed that his penis was bruised and that he was unable to maintain an erection. Physical examination reveals a dark, bruised, distorted penis. There is scant blood at the urethral meatus. Physical exam findings are depicted in Figure A. What is the next step in management? Topic Review Topic
FIGURES: A          

1. Counsel the patient on safe sex and reassure him that his penis will heal
2. Begin the patient on azithromycin
3. Obtain a doppler ultrasound
4. Obtain a urology consult and a retrograde urethrogram
5. Obtain an MRI of the abdomen and pelvis

PREFERRED RESPONSE ▶


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