Penile injuries are relatively uncommon in clinical practice and often occur during blunt trauma or rough sexual intercourse when the penis is erect. A smaller proportion of penis injuries result from sharp instrument injuries, penetrating injuries, or gunshot wounds.
Clinical Presentation:
Penile Contusion
Swelling, subcutaneous bruising, and hematoma formation may be observed.
Penile Fracture
Direct violence to the penis during erection can cause rupture of the tunica albuginea and corpus cavernosum, accompanied by a popping sound, severe pain, loss of erection, hematoma formation, and cyanosis of the skin.
Penile Constriction
This occurs when foreign objects are placed on the penis, leading to distal edema, ischemia, and necrotic changes.
Penile Dislocation
The penis may dislocate to the perineum or medial thigh due to tearing from the pubic ligaments.
Urethral Injury
Penetrating injuries to the penis caused by sharp objects may result in bleeding from the urethral meatus and difficulty in urination.
Diagnosis
Medical History and Physical Examination
In cases involving penile injury during an erectile state, patients often report hearing a snapping sound, followed by pain. Subsequent symptoms may include erectile dysfunction, swelling, discoloration, and penile misalignment, which can result in the formation of the typical "eggplant deformity." If the tunica albuginea and corpus cavernosum are ruptured, hematomas may spread to the scrotum, perineum, and suprapubic regions. Bruising caused by these hematomas can result in the relocation of the injured penis to the side opposite the tunica tear, and the rupture line in the tunica albuginea may be palpable.
Ultrasound Examination
Ultrasound serves as the preferred imaging method for assessing suspected penile fractures. It facilitates the identification of the precise location of penile injury.
Magnetic Resonance Imaging (MRI)
MRI represents a non-invasive and highly precise diagnostic option. When ultrasound fails to clearly determine the extent of the injury, MRI may be considered as an alternative.
Penile Cavernosography
The use of penile cavernosography in evaluating suspected penile fractures is generally not recommended due to the time required for the procedure, which may result in the exacerbation of the condition.
Treatment
Surgical Management
Suspected penile fractures should undergo prompt exploration and repair. Vertical ventral incisions of the penis are commonly used to expose the site of injury, while small transverse incisions may assist with the removal of localized hematomas. If the specific rupture site is unclear, a circumferential incision of the distal foreskin may be performed to expose all three compartments of the penis. For patients who have not undergone circumcision, a circumferential incision of the foreskin may pose a risk of ischemic necrosis to this area, and partial circumcision should be performed at the end of the repair. Efforts should avoid deep vascular ligation and excessive debridement of fragile erectile tissue. For injuries resulting from sharp object amputations, microsurgical repair of the dorsal penile blood vessels and nerves, including urethral reconstruction, is considered beneficial.
If microsurgical repair facilities are not available, the severed portion of the penis should be preserved. The distal segment can be rinsed with sodium chloride solution, wrapped in sterile gauze soaked in saline, and stored in a dry and sealed container for proper transportation to facilitate subsequent repair attempts.
Managing Complications
Postoperative infections of the penis should be treated with early interventions using anti-infective therapies. Erectile dysfunction may occur in some patients, and treatment options could include penile prosthesis implantation, vascular surgeries, or the use of phosphodiesterase type 5 (PDE5) inhibitors to promote restored erectile function.
In cases involving sharp object-related amputations, necrosis of the penile skin may develop. After several weeks of observation, stabilization, and debridement, full-thickness skin grafts from other bodily areas may be utilized. Adjunctive therapies for penile replantation, such as hyperbaric oxygen therapy, may be employed to aid skin healing.