Penile fracture and urethral injury repair

P. A. Tagdiwala, M. Megson, A. Pasyar, W. G. Lee

Penile fracture, urethral injury, penile repair

Penile fracture refers to the rupture of tunica albuginea of the penile corpora cavernosum. This can be associated with either a partial or a complete urethral injury (1). The patient presented in this video is a 35-year-old gentleman who presented post-trauma related to sexual intercourse causing immediate detumescence and swelling.

Penile fracture repair was performed using a midline ventral incision repair technique. Due to the suspected urethral injury requiring a suprapubic catheter insertion at the presenting hospital, a flexible cystoscopy was performed initially rather than the standard pre-operative imaging modality of ultrasound. The urethra was inaccessible at the level of the penile scrotal junction but within the penile urethra. A ventral midline incision along the penile raphe over the suspected fracture site is made. Dartos and Bucks Fascia were dissected to expose the tunica albuginea. Further dissection was required to determine the lateral extents of the injury. Stay sutures can then be placed to allow easier closure of the injury. The tunica albuginea was then sutured with PDS sutures, care was taken to ensure these are buried sutures to ensure the patient is unable to palpate these. Urethral injury was addressed by performing primary urethral anastomosis. Using a catheter, a complete transection was seen. The ends were dissected out to allow an end to end anastomosis. The anastomosis was checked for a leak with a table urethrogram using dilute betadine.

The procedure was successful and uneventful. A 3-week post-op urethrogram showed no leak. At 2 months post-operatively, he had good erectile function but a 30-degree ventral curvature which is being treated conservatively with a vacuum device.

Erectile dysfunction and penile curvature rates following surgery for penile fracture repair are reported to be 5% and 5% respectively. Conservative management results in 62% chance of erectile dysfunction and 35% chance of curvature (2).

1. Barros R, Silva MIS, Antonucci V, Schilze L, Kolfman L, Favorito LA. Primary urethral reconstruction results in penile fracture. Annals of the Royal College of Surgeons of England. 2018; 100(1): 21-25

2. Rees RW, Brown G, Dorkin T, Lucky M, Pearcy R, Shabbir M, Shukla CJ, Summerton DJ, Muneer A. British Association of Urological Surgeons (BAUS) consenus document for the management of male genital emergencies – penile fracture. BJU Int 2018; 122: 26-28