Penile fracture occurs during erection, as the expansion of
the corpora stretches the tunica albuginea and renders it
thinner and more vulnerable to trauma. Although the diagnosis
of penile fracture is often based on history and physical
examination, imaging can be particularly useful when
the clinical picture is not fully clear and when planning the
type of surgical approach. Among the radiological investigation,
USS is the most widely used, as it is readily available
and relatively inexpensive. However, although this form of
imaging is highly specific in detecting a fracture, it is not
very sensitive for detecting a cavernosal tear (6, 8, 9). On
the contrary, MRI scan of the penis is highly sensitive at
detecting the exact location of the tunical tear and allows
the surgeon to chose the best surgical approach. Therefore,
although more expensive and not always readily available
in the acute setting, MRI should be considered the gold
standard diagnostic investigation in case of suspected
penile fracture.Although penile degloving is the most commonly
used surgical approach, as it allows visualizing and
inspecting adequately all the corpora cavernosa and urethra,
it can be very morbid, due to the presence of diffuse
bruising and edema of the Dartos fascia. As 2/3 of fractures
occur all the way down on the proximal aspect of the shaft,
a complete degloving becomes an unnecessary procedure,
as a penoscrotal approach would guarantee adequate exposure
in these patients (7, 8). Magnetic resonance imaging or
USS of the penis play therefore a pivotal role for the identification
of the exact location of the tear and therefore allow
the surgeon to adequately choose the most appropriate surgical
approach. Surgery should be immediate, in order to
preserve as much cavernosal tissue as possible and to minimize
the formation of corporeal fibrosis, which would lead
to ED, penile shortening and curvature (3-5).
Just one of the things I read from some kind of medical journal that knows nothing. Okay bye!
