Ercan ÖĞREDEN, Doğan Sabri TOK, Erhan DEMİRELLİ, Osman Cagatay Ciftci, Mehmet KARADAYI, Ural OĞUZ

Komplet üretra rüptürüyle birlikte olan penil fraktür

AMAÇ: Penil fraktür, erekte penisin zorlanarak bükülüp kıvrılmasıyla korpus kavernozumun rüptüre olması sonucu gelişen ve acil cerrahi gerektiren bir travmadır. Olguların %1–40’ında penil fraktüre üretral travma da eşlik eder. Bu çalışmada komplet üretra rüptürüyle birlikte olan penil fraktür olgusını sunmayı amaçladık. OLGU SUNUMU: 51 yaşında erkek hasta koitus esnasında kırılma sesi sonrası ani gelişen ani ereksiyon kaybı, penis şaftında morarma ve ağrı şikâyeti ile acil servise başvurdu. Fizik muayenede penis şaftında sınırlı ekimoz, şişlik ve eksternal üretral meada hemoraji görüldü. Üretroraji olmasından dolayı hastaya üretrografi çekildi. Üretrografide orta üret- radan kontrast ekstravazasyonu olduğu izlendi. Hasta erken dönemde opere edildi. Midpenil bölgede her iki korpus kavernozumda yaklaşık 1’er cm boyutunda rüptür ile birlikte üretrada da komplet rüptür oldu- ğu görüldü. Kavernozal rüptürler ve uretral rüptür onarıldı. Postop 6. ay kontrolünde hastanın erektil disfonksiyon ve işeme ile ilgili semptomu yoktu. SONUÇ: Koitus sırasında duyulan “çıtırtı sesi”, şiddetli ağrı ve penil de- tümesans penil fraktürün tipik klinik bulgulardır. Meada kanama, he - matüri ve işemede zorlanma semptomları da varsa beraberinde üretral travma akla getirilmelidir. Bu hastalarda operasyon esnasında üretral onarım yapılması da gerekmektedir.

Penile fracture with complete urethral rupture

OBJECTIVES: Penile fracture is a trauma that develops as a result of the rupture of the corpus cavernosum by forcing the erect penis to bend and twist and requires emergency surgery. Urethral trauma accompanies penile fracture in 1–40% of cases. In this study, we aimed to present a case of penile fracture with complete urethral rupture. CASE REPORT: A 51-year-old male patient presented to the emergency service with the complaints of sudden loss of erection, bruising and pain in the penile shaft after a cracking sound during coitus. Physical examination revealed limited ecchymosis and swelling in the penile shaft and hemorrhage in the external urethral meatus. Urethrography was performed on the patient due to urethrography. On urethrography, it was observed that there was contrast extravasation from the middle urethra. The patient was operated in the early period. In the midpenile region, it was observed that there were ruptures of approximately 1 cm in both corpus cavernosum and complete rupture in the urethra. Cavernosal ruptures and urethral rupture were repaired. At the postoperative 6th month follow-up, the patient had no erectile dysfunction and voiding symptoms. CONCLUSIONS: The “crackling sound” heard during coitus, severe pain and penile detumescence are typical clinical findings of penile fracture. If there are symptoms of bleeding in the meatus, hematuria and difficulty in voiding, urethral trauma should be considered. In these patients, urethral repair is also required during the operation.

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1. Mydlo JH. Surgeon experience with penile fracture. J Urol. 2001;166:526–9. [CrossRef ]
2. Hanna KF, Jiang J, Burns N, Engelsgjerd JS, Davies JD. A case of traumatic penile fracture with simultaneous rupture of both corpora cavernosa and complete urethral transection. Urol Case Rep. 2020;34:101439. [CrossRef ]
3. Koifman L, Cavalcanti AG, Manes CH, Filho DR, Favorito LA. Penile fracture –experience in 56 cases. Int Braz J Urol. 2003;29:35–9. [CrossRef ]
4. Sökmen D, Çömez YI. Bilateral corpus cavernosum and complete urethral rupture: a double trouble. Cureus. 2021;13:e15481.[CrossRef]
5. Barros R, Silva M, Antonucci V, Schulze L, Koifman L, Favorito LA. Primary urethral reconstruction results in penile fracture. Ann R Coll Surg Engl. 2018;100:21–5. [CrossRef ]
6. Jack GS, Garraway I, Reznichek R, Rajfer J. Current treatment options for penile fractures. Rev Urol. 2004;6:114–20. https:// pubmed.ncbi.nlm.nih.gov/16985591/
7. De Rose AF, Giglio M, Carmignani G. Traumatic rupture of the corpora cavernosa: new physiopathologic acquisitions. Urology. 2001;57:319–22. [CrossRef ]
8. Zargooshi J. Sexual function and tunica albuginea wound healing following penile fracture: An 18-year follow-up study of 352 patients from Kermanshah, Iran. J Sex Med. 2009;6:1141–50. [CrossRef ]
9. El Atat R, Sfaxi M, Benslama MR, Amine D, Ayed M, Mouelli SB, et al. Fracture of the penis: management and long-term results of surgical treatment. Experience in 300 cases. J Trauma. 2008;64:121–5. [CrossRef ]
10. Hatzichristodoulou G, Dorstewitz A, Gschwend JE, Herkommer K, Zantl N. Surgical management of penile fracture and long- term outcome on erectile function and voiding. J Sex Med. 2013;10:1424–30. [CrossRef ]
11. McEleny K, Ramsden P, Pickard R. Penile fracture. Nat Clin Pract Urol. 2006;3:170–4. [CrossRef ]
12. Sounra Pandyan GV, Zaharani AB, Al Rashid M. Fracture penis: an analysis of 26 cases. ScientificWorldJournal. 2006;6:227–33. [CrossRef ]
13. Das S, Amar AD. Fracture of the penis. J Fam Pract. 1986;23:71– 2. https://pubmed.ncbi.nlm.nih.gov/3723086/
14. Kamdar C, Mooppan UM, Kim H, Gulmi FA. Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome. BJU Int. 2008;102:1640–4; discussion 1644. [CrossRef ]
15. Patil B, Kamath SU, Patwardhan SK, Savalia A. Importance of time in management of fracture penis: A prospective study. Urol Ann. 2019;11:405–9. [CrossRef ]
16. Sokolakis I, Schubert T, Oelschlaeger M, Krebs M, Gschwend JE, Holzapfel K, et al. The role of magnetic resonance imaging in the diagnosis of penile fracture in real-life emergency settings: comparative analysis with intraoperative findings. J Urol. 2019;202:552–7. [CrossRef ]
17. El-Taher AM, Aboul-Ella HA, Sayed MA, Gaafar AA. Management of penile fracture. J Trauma. 2004;56:1138–40. [CrossRef ]
18. Muentener M, Suter S, Hauri D, Sulser T. Long term experience with surgical and conservative treatment of penile fracture J Urol. 2004;172:576–9. [CrossRef ]