Penile fracture is a rupture of the tunica albuginea, the outer covering of the corpus cavernosum. It usually occurs during sexual intercourse when the erect penis hits the perineum or pubic symphysis. Clinically, there is an audible snap sound and rapid detumescence, followed by pain and swelling. Diagnosis is usually clinical but ultrasound or MRI may help if unclear. Early surgical repair is recommended to prevent complications like erectile dysfunction or penile curvature. The surgery involves a longitudinal incision over the defect and suturing the tear with absorbable sutures.

1. PENILE FRACTURE
Sukhdev, CMC Vellore

2. Introduction
• Rupture in tunica albuginea
• TA – outer covering of CC
• Thinnest in ventrolateral aspect

3. Aetiology
• Sexual intercourse – slipped out penis hitting against perineum/symphysis
• Masturbation
• Rolling over or falling on erect penis
• Taqaandan – Middle east – practice of manually bending the penis to achieve detumescence

4. Site of fracture
• Usually ventrolateral
• Bilateral in 10% of patients
• Concomitant urethral injury in 10% of patients
• Usually transverse laceration
• Pressures up to 1500 mm Hg
• 2 mm thick TA gets thinned out to 0.25 mm during erection

6. Clinical features
• Audible snap + rapid detumescence
• Pain, swelling and hematoma
• The snap – highly predictive of penile fracture

7. Signs
• Aubergine/eggplant/brinjal sign –
bruised penis with deviation to
opposite side of tear
• Rolling sign – penile skin can be
rolled over the hematoma
underneath

8. Diagnosis
• Clinical diagnosis
• If equivocal, USG or MRI can be used
• Cavernosography – time consuming; urologists and even radiologists
are not familiar with them
• When urethral injury is suspected, flexible cystoscopy at the time of
surgery is preferable over RGU

9. MRI – penile fracture

10. Cavernosogram

11. Differential diagnoses
• Suspensory ligament rupture – the tumescence stays
• Dorsal vein rupture – no snap

12. Management
• Medicolegal implication
• Documentation of baseline Erectile function mandatory
• Surgical repair – ASAP
• Surgery even if patient presents late –to avoid complications

13. Complications of Penile fracture
• ED
• Penile deviation
• Chronic pain
• Plaque formation
• Infection
• AV fistula

14. Surgery
• Lateral incision over the defect – when very certain about the defect
• Ventral incision
• Degloving incision – when uncertain about the site of tear
• Absorbable sutures in a longitudinal manner
• Saline instillation to ensure integrity of repair

15. Post operative management
• Di ethyl stilbestrol 1-2 mg for 1-2 weeks or a single injection of LHRH
agonists or ketoconazole