Penile fracture – clinical case presentation

Fracture of the penis is a rupture of the tunica albuginea of the corpus cavernosum, usually while the penis is rigid and erect. When erect, the albuginea layer stretches so far until its thickness reaches approximately 0.25 – 0.5 mm, compared with a 2 mm thick when flaccid. Thus the erect penis is much more vulnerable to serious damage from blunt trauma than the pendulous, flaccid penis. The most common cause of penile fracture is vigorous vaginal intercourse, more likely when woman is on top, but it can also occur during masturbation, forced bending of the erect penis or any mechanical trauma to the erect penis. The classic presentation described by the patient cracking or popping sound, followed by rapid detumescence, severe pain, ecchymosis of the penile skin, and swelling of the affected side with deviation of the penis shaft away from the affected side. In most cases, the penile fracture is a transverse corporeal tear close to the corpus spongiosum on the ventral aspect of penis shaft or on the lateral aspect and the tunical tear is usually 1 to 2 cm in length. The rupture can involve one or both corpora cavernosa as well as corpus spongiosum with the contained urethra therefore urethral rupture can also occur in. Most urethral injuries are associated with gross hematuria, blood at the meatus or inability to void, although the absence of these findings does not definitively rule aut urethral injury.