Urological Emergencies in Clinical Practice стр.88

Unless the injury is minor, the majority of such injuries should be managed by primary repair (Bertini and Corriere 1988, Gomez et al. 1993). Remove debris from the wound, e.g., particles of clothing. Obviously, necrotic tissue should be debrided,

118 J. REYNARD

but do not be overzealous, as the penis has a very good blood supply that aids subsequent healing. Repair the tunica of the corpora with absorbable or nonabsorbable sutures (with the knots buried). Repair anterior urethral injuries over a catheter with absorbable sutures.

PENILE FRACTURE

Definition

This is the traumatic rupture of the tunica albuginea of the erect penis resulting in rupture of one or both corpora cavernosa. The corpus spongiosum with the contained urethra may also rupture. It most commonly occurs during vigorous sexual intercourse. It may also occur during masturbation, forced bending of the erect penis or any mechanical trauma to the erect penis.

During intercourse the tunica albuginea, normally measuring approximately 2 mm in thickness, thins to about 0.25 mm as the penis expands. It is therefore vulnerable to rupture if the penis is suddenly and forcibly bent. Rupture of both corpora cavernosa can occur, as can that of the corpus spongiosum surrounding the urethra, i.e., urethral rupture.

History

Penile fracture usually occurs during sexual intercourse and in this situation it is thought to occur as a consequence of forcible contact of the erect penis with the female pubis. The patient may report hearing a sudden snap or popping sound, associated with sudden onset of pain in the penis and detumescence of the erection.

Examination

The penis is swollen and bruised (Fig. 5.28). It may be so swollen that it has the appearance of an aubergine. If Buck's fascia has ruptured, then bruising will extend onto the lower abdominal wall, and into the perineum and scrotum. A tender, palpable defect may be felt over the site of the tear in the tunica albug-inea. If the urethra is damaged, there will usually be blood at the urethral meatus or dipstick/microscopic haematuria. There may also be macroscopic haematuria, pain on voiding, or urinary retention.


Предыдущая Следующая