Ultrasound Assessment of Penile Fracture and Urethral Injury

Penile fracture is a serious injury characterized by the rupture of the tunica albuginea of the penile corpora cavernosa, commonly occurring due to trauma during sexual intercourse or manual manipulation. This condition can be associated with urethral injuries in up to 39% of cases, particularly those fractures involving the septum, necessitating a careful approach to maintain both sexual and voiding function. The video presented documents the case of a 35-year-old male who sought emergency treatment following a traumatic incident during intercourse, leading to immediate detumescence and swelling. The surgical repair utilized a midline ventral incision technique, preceded by ultrasound imaging to identify and mark the suspected fracture site. A flexible cystoscopy was performed to assess a suspected urethral injury, revealing an obstruction at the penile-scrotal junction. A ventral midline incision was made over the fracture site, allowing access to the tunica albuginea and identification of the fracture. Following dissection to define the extent of the injury, the tunica was sutured with buried PDS sutures, minimizing palpability for the patient. The urethral injury was addressed via primary urethral anastomosis, with thorough checks for leaks conducted using a dilute betadine urethrogram. The procedure was successful, and post-operative imaging showed no leaks three weeks after surgery. At two months, the patient reported good erectile function, though he experienced a 30-degree ventral curvature, which is being managed conservatively with a vacuum device. The BAUS consensus highlights that post-surgery complications such as erectile dysfunction and penile curvature occur in 5% of cases, while conservative management presents a significantly higher risk.