![]() ![]() Our experience tells us that the penile fracture is a very rare acute urology state, which occurs in the phase of penile erection and as a consequence of applying blunt force to corpus cavernosum, most often during sexual activity. TK was removed 7 days after the operation / 21 days after the operation in the cases of patients who had rupture of urethra. When the treatment was finished penis compression dressing was placed and was fixed to the anterior abdominal wall. Patients who had urethra rupture TT anastomosis with chromic catgut 4-0 were done with previous spatulation of urethra as a protection to the structure. Rupture was afterwards sutured with the absorbable PDS (polydioxanone) thread. Hematoma was removed and both cavernous and spongious body were examined in details with a verification of the place of rupture of tunica albuginea. Skin was pulled down to the root of the penis with the attention to the neurovascular elements. After placing stay stitch on glans penis and placing TK, subcoronar incision was performed, with the incision of tunica dartos to the Buck’s fascia. Additional diagnostics was not done to the patients. Operational field was prepared and antibiotics of a wide spectrum were routinely administrated. After taking history data and performing clinical examination, patients were treated as emergency cases. Most of them felt intense pain with a feeling of fracture of penis, and in the case of two patients, retention of urine developed. In all of the cases patients were injured during sexual intercourse. Patients turned to urologists in the first 1o hours after the injury occurred. In the period from 1998 to 2006, 23 patients with penile fracture were treated, age from 18 to 35 years old. ( 7) Three ways of incision can be used:Ĭomplications were retrospectively analyzed, after urgent surgical treatment of the patient with circumferential technique - degloving penile skin to root of penis. Surgical therapy needs to satisfy following criteria: adequate visualization, evacuation of hematoma, identification of place of injury, repair of a defect on tunica albuginea, adequate hemostasis, urethral injury reparation, placing TI<. The aim is for penis to have a standard shape and position to prevent erective dysfunction and enable normal voiding. Surgical treatment is considered to be the most appropriate form of treatment. This form of treatment is no more acceptable ( 5, 6) due to a very high rate of complications, no verification of urethra injuries with consequential fistulas, painful erections and erective dysfunctions. Cold compresses were locally applied, penis was immobilized, and antibiotic and analgesic protection was used. Before, penile fracture was treated in a conservative manner. Early reports recommend more conservative treatment but new researches are in favor of an urgent surgical intervention. There is a certain controversy in the approaches of penile fracture treatments. Following can be used in diagnostics of penile fracture: cavernosonography, retrograde urethrography, MRI and US of penis. Diagnosis is made based on a typical clinical features and anamnestic data. If Buck’s fascia is intact, hematoma is limited to penis, or if there is an injury of Buck’s fascia swelling and hematoma spreads to femoral region, anterior abdominal wall, scrotum and perineum ( 4). Penis is deformed usually in the shape of a letter “S” it’s swollen, with hematoma which is causing change of colour, voiding can be very painful and difficult, due to urethral injury, even with complete stop of urine flow ( 3). Physical examination is typical: sudden pain with sound phenomenon (popping), swelling and hematoma, which leads to penis detumescence and difficulties in voiding. In penile fracture, the cause of rupture is buckling of the tunica albuginea during erection, tunica stretches and changes it’s thickness from 2 mm to 0,25-0,5 mm, losses elasticity, and due to that penile fracture can occur by implication of blunt force or bending ( 2). Approximately 30% of cases are caused by sexual i11tercourse, various types of masturbation, and by industrial and other accidence. Penile fracture is considered urgent urologic state. In most cases it happens because tunica albuginea becomes thinner in penile erection, which under influence of blunt force may rupture, most often on penile lateral sides. Although real incidence is unknown, its frequency is approximately 1 of 175 000 hospitalized patients ( 1). Penis fracture is injury that rarely occurs. ![]()
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