Management of penile fracture

Abstract

A 40-year old male presented to the emergency department (ED) with penile swelling, bruising, and pain. He reported that while he was having vaginal intercourse with his female partner in the “missionary position,” his penis buckled. He reported slowly losing tumescence and that he felt minimal discomfort initially. He denied hearing the classical “snap,” which can be associated with a penile fracture. He noticed the rapid development of bruising and swelling of his penile shaft. He did not attempt any further sexual activity that night. The following day, despite the bruising and swelling, he was able to achieve an erection adequate for intercourse but there was too much pain to continue. At this point, he presented to the ED, approximately 36 hours after the original injury. He denied any hematuria or blood per urethra. On physical exam, the patient had extensive bruising along the shaft of the penis, including the skin superior to the suspensory ligament, as well as scrotal edema and ecchymosis (Fig. 1). There was no palpable granuloma or defect along the penile shaft. Since he presented late, with a somewhat atypical presentation, magnetic resonance imaging (MRI) was performed to evaluate for possible penile fracture (Fig. 2).