Urological Emergencies in Clinical Practice стр.83

The Anatomy of 'Butterfly-Wing' Bruising

Beneath the penile skin, the fascia of the penis consists of superficial fascia and deep fascia (Fig. 5.23).

Superficial Fascia

The superficial fascia of the penis (dartos fascia) is continuous with the membranous layer of the superficial fascia of the groin and perineum (Colles' fascia). Colles' fascia in the perineum is

110 J. REYNARD

Urological Emergencies in Clinical Practice

Figure 5.22. Butterfly bruising following rupture of Buck's fascia.

the equivalent of Scarpa's fascia in the abdomen (Colles' fascia and the dartos fascia together form the membranous layer of the superficial fascia of the perineum and penis). Beneath the dartos fascia is Buck's fascia (the deep layer of the superficial fascia).

Deep Fascia

Beneath Buck's fascia is the deep fascia of the penis (the tunica albuginea), which covers the two dorsal rods of erectile tissue, the corpora cavernosa, and the ventrally located corpus spongiosum, which surrounds the urethra (Fig. 5.23).

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Urological Emergencies in Clinical Practice

Attachments of Superficial Fascia of Penis and Perineum

Distally Buck's fascia is firmly attached to the base of the glans (the coronal sulcus), and laterally it is attached to the pubic rami and to the ischial spines and tuberosities. The attachments of Colles' fascia are, inferiorly, the fascia lata (the deep fascia of the thigh) in the upper mid-thigh, posteriorly to the perineal body just in front of the anus, laterally to the inguinal ligaments, and superiorly the coracoclavicular fascia (Fig. 5.22).

if the urethra has ruptured, but Buck's fascia is intact, bruising is confined in a sleeve-like configuration, along the length of the penis, by Buck's fascia. if Buck's fascia has ruptured, the extravasation of blood and thus the subsequent bruising, is limited by the attachments of Colles' fascia (the superficial perineal fascia).

Confirming the Diagnosis

The history, symptoms, and/or clinical signs described above are indications for retrograde urethrography (see Posterior Urethral injuries, above). The key thing is to position the patient to allow adequate demonstration of the anterior urethra. The patient should lie at a 45-degree oblique angle with the bottom leg flexed at the hip and knee and the top leg completely straight and extended. An anterior urethral rupture is diagnosed when there is extravasation of contrast. if the patient has blood at the meatus, but there is no extravasation of contrast, the patient has a ure-


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