4/9/2024 0 Comments Sexual positionAdditionally, the patient may have resultant scar tissue development resulting in curvature of the penis, painful erections, and a consequent loss of length of the erect penis. Special attention is necessary to ensure foley placement intraoperatively during cystoscopy does not cause further harm due to a missed urethral injury.Ĭonservative management of penile fracture has significantly more complications than surgical intervention, most concerning erectile dysfunction. Īdditionally, there is a significant risk for concomitant urethral injury. Surgical complications may also include plaques/nodules, curvature, erectile dysfunction, pain, infection, mild chordee, reoperation, aneurysm, wound edema, and urinary disorders. Counseling is also essential to guide a patient through the postoperative period to minimize sexual dysfunction following a penile fracture. Patients may also exhibit changes in sexual practices due to fears of recurrent injury. Many patients will have anxiety over sexual performance after a penile fracture. Some may be limited to the immediate postoperative period however, many patients will experience long-lasting dysfunction. All patients who are subject to penile fracture will experience some degree of sexual dysfunction. The most obvious and concerning complication of penile fracture is sexual dysfunction. Patients should be instructed to refrain from intercourse during the postoperative period as well. Postoperatively patients should receive routine post-surgical care instructions, including incisional care and information regarding indications to return to the emergency department. One study showed that a delay of approximately 8 hours resulted in substantial increases in erectile dysfunction postoperatively. Studies have demonstrated a significant change in functional outcomes with the delayed repair of penile fractures. Buck's fascia should also undergo repair, and finally, skin closure achieved with non-absorbable suture. The type of suture and suture material is entirely user dependant. An absorbable suture is then used to repair the tunica defect. Hematoma evacuation should allow for direct visualization of tunica defects. After opening the skin, the hematoma should be evacuated. Circumcising or linear incision is acceptable for the opening of the skin. After demonstrating that the patient is an acceptable surgical candidate, the operator should plan for the identification of the repair of the tunica rupture. Treatment of penile fractures should be prompt operative repair. This testing could either be intraoperative cystoscopy or retrograde urethrogram. The American Urological Association guidelines recommend provocative testing with the intent to rule out urethral injury if there is a suspicion that this may be the case. Blood at the urethral meatus, hematuria, and difficulty voiding should prompt assessment for urethral injury. Workup surrounding penile fractures should include preoperative laboratory evaluation, and other studies to rule out concomitant urethral injury may be warranted. One study demonstrated 100% sensitivity along with 77.8% specificity for the identification of penile fracture by MRI. MRI, while not the most readily available test, has been shown to assist in the diagnosis and perioperative management of penile fractures. CT certainly is widely available and has been demonstrated to be helpful in identification in location and size of injury to aid surgical repair. ![]() However, if there is a significant hematoma, it may increase difficulty in the diagnosis of tunica rupture by the US. The US may show irregular defects at the site of cavernosa rupture. ![]() Ultrasound (US) is readily available in most areas however, there is some debate over its clinical utility as the actual test is operator dependent, and successful identification of injury requires specific expertise. In addition to clinical suspicion for tunica rupture, multiple imaging modalities can be useful to identify penile fractures. However, suspicion of penile fracture based on history should warrant a thorough evaluation to rule out compounded injuries, including dorsal penile vein and nerve injuries, while simultaneously correctly diagnosing the penile fracture. Correct identification of penile fracture is typically a clinical diagnosis.
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