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Sex-related penile fracture with complete urethral rupture: A case report and review of the literature

Marco Garofalo, Lorenzo Bianchi, Giorgio Gentile, Marco Borghesi, Valerio Vagnoni, Hussam Dababneh, Riccardo Schiavina, Alessandro Franceschelli, Daniele Romagnoli, Fulvio Colombo, Beniamino Corcioni, Rita Golfieri, Eugenio Brunocilla
  • Marco Garofalo
    Department of Urology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Lorenzo Bianchi
    Department of Urology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Marco Borghesi
    Department of Urology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Valerio Vagnoni
    Department of Urology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Hussam Dababneh
    Department of Urology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Riccardo Schiavina
    Department of Urology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Alessandro Franceschelli
    Andrology Unit, Sant’Orsola-Malpighi Hospital, Bologna, Italy
  • Daniele Romagnoli
    Department of Urology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Fulvio Colombo
    Andrology Unit, Sant’Orsola-Malpighi Hospital, Bologna, Italy
  • Beniamino Corcioni
    Department of Radiology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Rita Golfieri
    Department of Radiology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy
  • Eugenio Brunocilla
    Department of Urology, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy

Abstract

Objective: To present the management of a patient with partial disruption of both cavernosal bodies and complete urethral rupture and to propose a non-systematic review of literature about complete urethral rupture. Material and method - Case report: A 46 years old man presented to our emergency department after a blunt injury of the penis during sexual intercourse. On physical examination there was subcutaneous hematoma extending over the proximal penile shaft with a dorsal-left sided deviation of the penis and urethral bleeding. Ultrasound investigation showed an hematoma in the ventral shaft of the penis with a discontinuity of the tunica albuginea of the right cavernosal corporum. The patient underwent immediate emergency surgery consisted on evacuation of the hematoma, reparation the partial defect of both two cavernosal bodies and end to end suture of the urethra that resulted completely disrupted. Results: The urethral catheter was removed at the 12-th postoperative day without voiding symptoms after a retrograde urethrography. 6 months postoperatively the patients was evaluated with uroflowmetry demonstrating a max flow rate of 22 ml/s and optimal functional outcomes evaluated with validated questionnaires. 8 months after surgery the patients was evaluated by dynamic magnetic resonance (MRI) of the penis showing only a little curvature on the left side of the penile shaft. Conclusion: Penile fracture is an extremely uncommon urologic injury with approximately 1331 reported cases in the literature till the years 2001. To best of our knowledge from 2001 up today, 1839 more cases have been reported, only in 159 of them anterior urethral rupture was associated and in only 22 cases a complete urethral rupture was described. In our opinion, in order to prevent long term complications, in case of clinical suspicion of penile fracture, especially if it is associated to urethral disruption, emergency surgery should be the first choice of treatment.

Keywords

penile fracture, Complete urethral rupture, Surgical repair

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Submitted: 2015-09-29 13:14:27
Published: 2015-09-30 11:12:52
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Copyright (c) 2015 Marco Garofalo, Lorenzo Bianchi, Giorgio Gentile, Marco Borghesi, Valerio Vagnoni, Hussam Dababneh, Riccardo Schiavina, Alessandro Franceschelli, Daniele Romagnoli, Fulvio Colombo, Beniamino Corcioni, Rita Golfieri, Eugenio Brunocilla

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