The
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Penile Fracture
Robert J. Hartman, Jr., M.D. Brigham and Women’s Hospital Boston, MA
[email protected]
A
healthy 42-year-old man presented to the emergency department after the acute onset of penile pain during sexual intercourse. The erect penis had inadvertently collided with his partner’s perineum. He heard a snap, noticed a rush of blood from the meatus, had immediate detumescence, and had severe pain. The penile “fracture” refers to a tear in the tunica albuginea, the watertight fibrous outer sheath of the corpora cavernosa that is responsible for maintaining the structural integrity of an erection. Disruption of the tunica results in a loss of blood outside the corpora, causing a hematoma. The classic eggplant deformity (swelling, discoloration, and deviation away from the defect in the tunica) can be seen. If the fracture involves the urethra, blood will extravasate through the urethra. On the basis of the clinical presentation, the patient was taken to the operating room for emergency repair. The patient had an uneventful postoperative course and was discharged from the hospital the morning after surgery. Sequelae of penile fracture include erectile dysfunction due to disfiguring plaque formation, penile curvature, and possible nerve injury. The patient was seen 3 months and 6 months after surgery and had regained erectile function without appreciable plaque formation or penile curvature.
DOI: 10.1056/NEJMicm1404224 Copyright © 2015 Massachusetts Medical Society.
n engl j med 372;11 nejm.org march 12, 2015
1055
The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF PITTSBURGH - MAIN on March 16, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
n e w e ng l a n d j o u r na l
of
m e dic i n e
images in clinical medicine Lindsey R. Baden, M.D., Editor
Penile Fracture
Robert J. Hartman, Jr., M.D. Brigham and Women’s Hospital Boston, MA
[email protected]
A
healthy 42-year-old man presented to the emergency department after the acute onset of penile pain during sexual intercourse. The erect penis had inadvertently collided with his partner’s perineum. He heard a snap, noticed a rush of blood from the meatus, had immediate detumescence, and had severe pain. The penile “fracture” refers to a tear in the tunica albuginea, the watertight fibrous outer sheath of the corpora cavernosa that is responsible for maintaining the structural integrity of an erection. Disruption of the tunica results in a loss of blood outside the corpora, causing a hematoma. The classic eggplant deformity (swelling, discoloration, and deviation away from the defect in the tunica) can be seen. If the fracture involves the urethra, blood will extravasate through the urethra. On the basis of the clinical presentation, the patient was taken to the operating room for emergency repair. The patient had an uneventful postoperative course and was discharged from the hospital the morning after surgery. Sequelae of penile fracture include erectile dysfunction due to disfiguring plaque formation, penile curvature, and possible nerve injury. The patient was seen 3 months and 6 months after surgery and had regained erectile function without appreciable plaque formation or penile curvature.
DOI: 10.1056/NEJMicm1404224 Copyright © 2015 Massachusetts Medical Society.
n engl j med 372;11 nejm.org march 12, 2015
1055
The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF PITTSBURGH - MAIN on March 16, 2015. For personal use only. No other uses without permission. Copyright © 2015 Massachusetts Medical Society. All rights reserved.
