Case Report

Recurrent Penile Fracture

Shabir Ahmad Mir, Mumtaz Din Wani

Postgraduate Department of Surgery Government Medical College, Srinagar

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Submitted May 29, 2013

Accepted July 26, 2013

Published July 27, 2013

Abstract

The fracture of the penis occurs when an erect penis is subjected to a blunt trauma that bends it abnormally. The tear in the tunica albuginea is usually transverse1. Urethral injury occurs in 20% of these patients2. Surgical treatment consists of exposure of the fracture site by a local incision or by degloving the penile skin from a distal circumcoronal incision1 and suturing the tear in the tunica albuginea with absorbable1, 2 or non-absorbable sutures3. Collagen deposition is complete 6 weeks after the injury but there is a continuous gain in the tensile strength of the scar for 2 years, caused by remodeling of collagen.

Introduction

The fracture of the penis occurs when an erect penis is subjected to a blunt trauma that bends it abnormally. The tear in the tunica albuginea is usually transverse [1]. Urethral injury occuirs in 20% of these patients [2]. Surgical treatment consists of exposure of the fracture site by a local incision or by degloving the penile skin from a distal circumcoronal incision [1] and suturing the tear in the tunica albuginea with absorbable [1, 2] or non-absorbable sutures [3]. Collagen deposition is complete 6 weeks after the injury but there is a continuous gain in the tensile strength of the scar for 2 years, caused by remodeling of collagen.

Case Report

A 40 year old male presented to us in the Department of Surgical Emergency with the recurrent history of sudden detumesence after hearing a cracking sound during sexual intercourse with her wife at midnight. Detumescence was followed by pain, swelling and penile deformity. This incident had occurred seven hours before he reported to the surgical emergency department. Local examination revealed a swollen penis deviated to the right. The patient was able to pass urine after the injury. The fracture site was identified as a palpable defect in the left tunica albugina. A circumcoronal incision was made 0.5 cm proximal to coronal sulcus and the shaft degloved. A 1.5cm transverse rent was identified in the mid lateral part of left corpus cavernosum after evacuation of the haematoma.

 

No separate scar tissue of previous fracture was visible as the present rent occurred at the site of previous fracture, as was confirmed by the site mentioned in his previous records. The rent was repaired by non-absorbable (polypropylene) inverting sutures. The patients made an uneventful recovery and had no erectile dysfunction and resumed sexual intercourse after a period of 7 months.

 

Nineteen months back patient had a similar episode of penile fracture. The site of fracture was mentioned in the previous records of the patient exactly the same as the fresh episode of penile fracture. At that time fracture was repaired by using 3/0 vicryl. The patient had an uneventful recovery and had resumed his sexual activity four months after the repair.

 

Discussion

In the largest study of 300 fractured penises, no case of refracture was documented [4]. A thorough review of the medical literature revealed that only 5 cases of recurrent penile fracture have been reported. Among these 5 cases, two were ipsilateral fractures and on the same site as the previous; one was ipsilateral but at different site. Other two were cases of contralateral fractures..

Our cases is the first case of refracture at the same site (previous site) occurring after a gap of nineteen months, being the shortest gap ever reported in the literature, as the other two cases of this kind which have been already reported in the literature, are at the time gaps of two years and nine years.

Only two cases of refracture at the original sites have been reported in the medical literature [3,5]. In both the cases, the author recommended the use of non-absorbable suture material for repair to minimize the risk of refracture. However, the case of ipsilateral recurrent penile fracture at a different site demonstrates that when vicryl is used, the scar at 20 months could withstand intracorporeal pressures that would result in fracture at another site on the same side [6]. The argument that the routine use of non-absorbable sutures decreases the risk of refracture needs to be reexamined, especially since this complication has occurred only twice.

Kattan et al. (1983) [3] reported the first case of recurrent ipsilateral fracture of the penis and advocated non-absorbable sutures for the closure of the defect in the tunica albuginea. Use of non-absorbable sutures can cause discomfort during sexual intercourse as the knots of the sutures can be felt under the thin penile skin by the patient for a long time [3]. Sexual intercourse and masturbation should be avoided during the first 6 weeks of the repair to prevent any increase in the size of haematoma around the sutured wound. A large haematoma leads to the formation of a weak scar which makes the penis prone to refracture [3]. As this type of injury is so rare there are no prospective randomized clinical trials on the best type suture material used in its repair. Because our patient’s penis fractured at the same site after nineteen months, we agree with the view points of the authors of the previous two similar cases and recommend the use of nonabsorbable sutures in such cases.

S. Sharma et al (2009) [7] reported the second case of refracture of the penis involving the contralateral corpus cavernosum. A thorough Medline literature review revealed only one such previous case [8]. Contralateral fracture can be explained with the scar tissue at the previous site acting as the source of unequal distribution of tension in the corpora leading to rupture of contralateral side [6]. During the repair of the penile fracture care should be taken to ensure that the corpora are equal in length during artificial erection test [7].

Authors Contributions

SAM : preparation of manuscript.

MAW: preparation of manuscript.

Ethical Consideration

Written informed consent was obtained from patient for publication of this case report.

Conflict of Interest

The authors declare that there are no conflicts of interest.

Acknowledgement

None

Funding

None

References

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