![]() ![]() The authors graciously thank the Keith and Lynda Harring Fund for Urologic Research at Penn State Health for support of this work. Although not always readilyĪvailable and more costly, it provides valuable information that can reduce the need for invasive surgical incisions and associated Use of MRI preoperatively can help to determine appropriate surgical approach to penile fracture. Patient’s fracture, a more focal penoscrotal incision better served our patient. Unnecessarily cause additional complications, such as diffuse swelling of the Dartos fascia. Incision is the most commonly used technique for exploring the corpora cavernosum and penile urethra. Degloving of the penis with a circumferential Surgical exploration remains a safe option in management of penile fractures. In making decisions regarding subsequent surgical management. Although not as readily available, the higher sensitivity and negative predictive value associated with MRI is necessary It also provides the added benefit of being able to detect associated hematomas and Ultrasound may not provide adequate information. In contrast, MRI has superior soft-tissue resolution and is more effective in determining tunica tear location and defect length where Otherwise, it is heavily operator dependent and may miss tunica tears depending on size and location, particularly at the base of the penis. It may detect associated hematoma and tunica tear if the defect is large enough Non-invasive diagnostic tool, it has limitations. Previous studies suggest that although ultrasound is an inexpensive and In this case, pelvic MRI findings shaped the decision to utilize a more conservative penoscrotal incision to repair our patient’s penileįracture, as opposed to a more invasive sub-coronal incision. Preoperative imaging is utilized to confirm the correct diagnosis and dictate appropriate surgical approach to repair penile fractures. The patient was transferred to the PostAnesthesiaĬare Unit (PACU) in stable condition, and discharged later that day. Were closed in a running fashion over the corporotomy using 2-0 Vicryl sutures. ![]() The medial-most aspect was identified and the corporotomy was closed with 2-0 Vicryl interrupted sutures. The corporotomy was 1.5 to 2cm in length. After Buck’s fasĬia was dissected, a small hematoma was evacuated, revealing the edge of the tunica albuginea. A 1.5cm laceration proximal to the lateral tunica albuginea of left corpus cavernosum was found. A penoscrotal incision was made down to the area identified by MRI to be in the left proximal Haemorrhage and edema involving left corpus cavernosa and extending into adjacent soft tissues. Pelvic MRI revealed focal rupture of tunica albuginea with Physical examination revealed testicular and penile swelling most prominent on the left lateral aspect, ecchymosis on the scrotum,Īnd rightward deviation of the penile shaft reportedly worse than baseline. Previously, he was treated with Xiaflex injections for Peyronie’s disease, and his last injection was over 8 months ago. The following morning, the pain subsided but there was bruising and tenderness to touch. During sexual intercourse the night prior, he reported a sudden “popping” sound, followed by rapid detumescenceĪnd acute pain. Case ReportĪ 39-year-old man with past medical history significant for Peyronie’s disease presented to the Emergency Department for evaluation Therefore, it is often the primary method of evaluation. Ultrasound is an inexpensive and easy-to-access imaging Site of tunica defect and determine the appropriate surgical repair method. Use of penoscrotal approach instead lessens the overall dissection required and reduces complications associated with the traditionalĭegloving approach Preoperative imaging, such as ultrasound and Magnetic Resonance Imaging (MRI) are used to determine the exact However, in 2/3 of cases, the tear is located at the level of the penoscrotal junction. Penile degloving is the most commonly used surgical approach, allowing for adequate visualization of Early surgical exploration is crucial to preserve long-term erectile function, avoid penile deformity, and repairĪssociated urethral rupture. The patient reports a “popping” sound, followed by immediate detumescence, diffuse swelling of the penis and angulation towards the It usually occurs due to non-physiologic bending of an erect penis during vigorous sexual intercourse. Penile fracture is an uncommon urologic emergency involving unilateral or bilateral rupture of tunica albuginea of the corporaĬavernosum. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |