Management of Penile Fracture with ConcomitaComplete Urethral Transection: A Case Report and Review of Intra-operative Management Principles

A. Elauri, J. K. Yee, A. G. Reddy, A. Perecman, R. Golan, J. J. Andino, R. Jayadevan

Corporoplasty, megacorpora, corporal tuck

The video presents the multidisciplinary surgical management of a 38-year-old male with severe obesity who sustained a bilateral corpora cavernosa fracture and a complete urethral transection following a coital penile fracture. The presentation begins by outlining the surgical setup, the patient's history of present illness, and relevant preoperative imaging, notably the pelvic MRI confirming the focal disruptions. The surgical footage then highlights the critical steps of the reconstructive procedure. The video captures the active bleeding from the bilateral corporal injuries and details their primary repair using 4-0 PDS sutures. Next, we demonstrate the exposure and mobilization of the urethral stumps, emphasizing the importance of precise mucosal-to-mucosal bites without excising excess mucosa to prevent narrowing of the urethral lumen. Next, following a tension-free end-to-end urethral anastomosis, a saline flush test is demonstrated, showing full distal distention without any leakage to confirm a watertight seal. Finally, the video showcases the application of an umbilical tissue graft with hope of aiding in soft tissue healing. This video may be valuable for any and all urologists who take call as it provides a step-by-step visual guide to managing a catastrophic urological emergency and demonstrates how advanced imaging and fundamental surgical techniques can be utilized to prevent urethrocavernosal fistulization in high-risk patients. The patient has been recovering well, with no lower urinary tract symptoms and no stricture or leakage, as well as return of spontaneous erections.

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