Penile fracture is rare, but it is a urological emergency that always requires immediate attention. Moreover, penile fracture has been reported more frequently in recent years. It may have devastating physical, functional, and psychological consequences if not properly managed in time. The objective of this study was to highlight the causes, clinical presentation, and outcomes of cases of penile fracture. This was a prospective observational study extending from November to November Each patient underwent a thorough clinical evaluation and received proper treatment.
Twenty patients with penile fracture, aged 19 to 56 years mean, 28 years were evaluated in this study. Vaginal intercourse was the most common mechanism of injury. Nineteen patients were treated surgically. The patients underwent six months of follow-up, and were evaluated with local examinations, questionnaires, and colour Doppler ultrasonography as necessary. Although penile fracture is an under-reported urological emergency, its incidence is increasing.
It is usually diagnosed based on a clinical examination, but ultrasonography can be very helpful in diagnosis. Especially in cases where treatment is delayed, surgery is preferable to conservative management, because it is associated with better outcomes and fewer long-term complications.
Although penile fracture has traditionally been considered a serious but rare urological emergency, its incidence has increased to the point it can no longer be considered rare. Penile fracture is a misnomer; in fact, this condition is defined as a rupture of the tunica albuginea of the corpus cavernosum. The usual cause is abrupt bending of the erect penis by blunt trauma, which may occur during sexual intercourse, masturbation, rolling over on the bed, or falling onto the erect penis.
The presentation of penile fracture may vary depending upon the time interval between occurrence and treatment and on the presence of associated injuries. Delay in presentation is mainly due to fear and embarrassment.
The patient may recall hearing a cracking pop-up sound, followed by rapid detumescence of the erect penis and intense local pain. Hematoma, bruising,
Anup kumar wife sexual dysfunction deformity known as 'eggplant deformity' of the penis then follow [ 12 ]. A palpable tunical defect and hematoma with a 'rolling sign' are usually considered pathognomonic features for this condition [ 3 ].
Associated urethral injuries may occur in a fair number of patients. In the past, the diagnosis of this condition was usually clinical, based on high clinical suspicion and proper history taking. However, novel imaging techniques like ultrasonography USG [ Anup kumar wife sexual dysfunction ], retrograde urethrography RGU [ 19 ], and the like help confirm the proper diagnosis when a diagnostic dilemma occurs [ 7 ]. As stated earlier, penile fracture may lead to devastating functional, physical, and psychological complications if not managed properly and in a timely manner [ 10 ].
The protocol for managing penile fracture has evolved from a conservative approach to the current standard of care involving immediate surgical exploration [ 14611 ]. The recommended procedure involves a degloving incision, evacuation of the haematoma, and repair of the rent of the tunica albuginea with absorbable or non-absorbable sutures [ 6 ]. Unsatisfactory penile curvature and erections, urethral strictures, and urethral cutaneous fistulae are among the complications that have been associated with the delayed treatment of penile fractures [ 412 ].
In our study, we analysed different aspects of penile fractures, including different modes of occurrence and presentation. Our study also addressed the management and outcomes of penile fracture, with special reference to the preservation of sexual function.
This was a prospective observational study extending from November to Novemberincluding all patients admitted for blunt trauma to the erect penis. During this period, 20 cases of penile fracture "Anup kumar wife sexual dysfunction" treated in our institute. Penile fracture was mainly diagnosed on clinical grounds, based on a proper history and clinical examination.
Both surgical and conservative treatment strategies were employed. Distal degloving was performed in 15 cases, and a direct lateral incision was performed in four cases Fig. Evacuation of haematoma and repair of the tunical tear with absorbable sutures was carried out. Limited distal circumcision was performed in 12 cases.
Perioperative catheterisation was performed in 16 cases, including the two cases involving urethral injuries. In Anup kumar wife sexual dysfunction cases, six months of follow-up were completed.
In the third month after treatment, each patient's erectile function was evaluated. Both married and unmarried patients with a partner were evaluated with the IIEF-5, while unmarried patients without a partner were evaluated with the GASP. Colour Doppler studies were performed in patients Anup kumar wife sexual dysfunction ED.
The vascular RI was defined as follows: When the penile fracture occurred, four of the patients were having sexual intercourse with the woman on top, three were watching an erotic film during masturbation, and two had ingested sildenafil tablets as a sexual stimulant. Two patients experienced bleeding through the urethra. Diagnosis was possible on clinical grounds in 19 cases. One patient had a typical history, but the findings of a physical examination were not conclusive.
USG was performed in 19 cases.
A tunical tear was observed in 15 cases, and a tear of 2 to 3 mm was sufficient for diagnosis in the case in which a clinical diagnosis was not possible.
RGU was performed in one case, in which the patient
Anup kumar wife sexual dysfunction suspected to have a urethral injury. Surgical treatment was provided in 19 cases, while one case with a small tear was treated conservatively. A right corporal tear was observed in 12 cases, and 12 cases had a tear in the proximal third of the penis. Repair was performed using absorbable sutures in all cases Table 2. Urethral injury was observed in two cases; in one case, the urethral injury was detected preoperatively by RGU, and in the other case it was detected during exploration through a distal degloving incision.
Two patients showed distal skin necrosis and were managed conservatively Table 3. Follow-up was planned, involving a clinical evaluation during the third week and an evaluation of sexual function during the third month. At the first follow-up, all of the patients were evaluated, and two patients found to have a small nodule, which regressed spontaneously.
The first documented report of penile fracture is credited to the Arab physician Abu al-Qasim al-Zahrawi in Cordoba, more than 1, years ago [ 11 ]. In the modern medical literature, the first case of penile fracture was described by Malis and Zur [ 16 ] in The usual cause of penile fracture is abrupt bending of the erect penis by blunt trauma, which may occur during sexual intercourse, masturbation, rolling
Anup kumar wife sexual dysfunction in the bed, or during the practice known as 'taghaandan,' in which the erect penis is pushed down to Anup kumar wife sexual dysfunction detumescence, resulting in a click [ 1 ].
The mechanism of injury depends on sociocultural characteristics, masturbation habits, and the specific sexual activities that an individual engages in. The causes of penile fracture in our case series were similar to what has been reported in most other published series, with sexual intercourse being the most common cause.
Our literature review found
Anup kumar wife sexual dysfunction no data have been published regarding the time of occurrence of penile fractures. Most of the patients in our series were injured in the late night and early morning, which may reflect the circadian rhythm of testosterone secretion.
However, numerous recent studies have assessed the diagnostic role of various imaging modalities, such as USG [ 46817 ], cavernosography [ 618 ], RGU [ 19 "Anup kumar wife sexual dysfunction," and magnetic resonance imaging [ 619 ]. We found USG to be a very helpful tool in the diagnosis of penile fracture. RGU is highly sensitive, but is not essential for the diagnosis of urethral injury, since a suggestive history and proper surgical exposure with intraoperative retrograde instillation of methylene blue may be sufficient to diagnose urethral injury.
The protocol for managing penile fracture has evolved from a conservative approach to the current predominant approach that involves immediate surgical exploration [ 14611 ]. Multiple contemporary publications have confirmed that suspected penile fractures should be promptly explored and surgically repaired.
Recently, Yapanoglu et al [ 21 ] and Gamal et al [ 22 ], in two similar studies, found that immediate surgical repair resulted in good outcomes and was superior to conservative treatment. In our series, surgical exploration was performed in 19 cases [ 16 ], while conservative management was employed in one case involving a small fracture with no signs of swelling or deviation. Hinev [ 23 ] has recommended conservative management when the cavernosal body is intact.
Muentener et al [ 10 ] found that spontaneous healing without complications is probable for tears in the tunica albuginea without extensive haematoma or concomitant urethral injury, which may explain the outcome of our case.
Agarwal et al [ 11 ] also reported a similar case in their series. In sharp contrast to the abovementioned reports, the conservatively treated patient in our case series had a very good outcome. The proper selection of patients for conservative treatment may have led to the good outcome of conservative treatment in this case.
Penile fracture most commonly occurs on the right side and the ventrolateral aspect of the proximal third of the penis. The type and location of the incision is operator-dependent. Although small lateral incisions may be used for localized haematomas or palpable tunical defects [ 26 ], a distal circumcising degloving incision is appropriate in most cases, as advocated by Zargooshi [ 1 ], Miller and McAninch [ 9 ], and Mydlo [ 25 ].
In addition to being the most cosmetically favourable type of incision, distal degloving
Anup kumar wife sexual dysfunction allows exposure to the entire tunica bilaterally, facilitating the diagnosis and repair of coexisting urethral and contralateral injuries. The decision to place a Foley catheter is operator-dependent. Some surgeons have reported routinely catheterizing their patients overnight, whereas others have advocated using a urethral catheter only when injuries are close to the urethra [ 56925 ].
The use of a catheter helps the intraoperative dissection without harming the urethra, facilitates the application of a pressure dressing, prevents postoperative wound contamination, and is unlikely to be harmful.
In uncircumcised patients, strong consideration should be given to performing limited circumcision at the conclusion of the repair procedure, because wide mobilization of the foreskin may place the distal prepuce at risk for ischemia [ 2 ]. We found distal skin necrosis in two out of three cases where a distal degloving incision was made but circumcision was not performed.
The differential diagnosis of penile fracture may include false fracture or rupture Anup kumar wife sexual dysfunction the dorsal vein or the artery of the penis [ 262728 ]. The timing of surgery influences its long-term success. Patients undergoing repair within eight hours of injury have been found to have significantly better long-term results than patients who underwent surgery 36 or more hours after the fracture occurred [ 218 ].
One patient underwent surgery hours after trauma, and the only complication was a mild wound infection. The two patients who had ED in the follow-up were operated on 17 and 88 hours after injury.
Thus, in our study, delays in surgery did not seem to have a particularly strong effect on the outcome. Moreover, a lack of consensus exists regarding the need for postoperative suppression of penile erection with diazepam or oestrogen; this approach has been routinely used in some studies, but declared to be unnecessary in others [ 29 ]. The use of diazepam helps prevent early erections that might have harmful effects, and helps to allay the anxiety that may occur with such trauma.
In our series, no definite protocol regarding the use of erectile suppressants was followed, and they were used according to the surgeon's preference. Supportive evidence in the literature was not available in this regard. However, pain during erection causes detumescence in and of itself, meaning that the use of such drugs is unnecessary. The immediate postoperative outcomes also have varied in different case series. In our series, all patients were discharged on the third postoperative day, with the exception of four patients who developed complications.
Two had mild skin infections and two had distal skin necrosis. Anup Kumar;, MCh; Pawan Vasudeva;, MCh; Niraj Kumar;, DNB In this study, we assessed effects of PVP by HPS laser on erectile function. Rajkumar Singha Mahapatra, Anup Kumar Kundu, and Dilip Kumar Pal. Patients' sexual function was evaluated using questionnaires and sexual four of the patients were having sexual intercourse with the woman on top. Anup Kumar Kundu's 59 Anup kumar wife sexual dysfunction works with citations and reads, There was a significant impact on sexual function (assessed by IPSS sexual function Here we report an uncommon case of a year-old woman who presented.