Dorsal vein injuries observed during penile exploration for suspected penile fracture.
BACKGROUND
Penile fracture is a rare injury, bearing potential impairment of erectile function if not treated. Patients with clinical presentation of a penile fracture commonly undergo early surgical exploration with the intention to repair a tunica albuginea tear.


OBJECTIVE
We present a group of men who presented with a penile hematoma following trauma to the erect penis. Exploration revealed an intact tunica albuginea and a dorsal vein tear.


METHODS
Eighteen men (mean age 38 years, range 20-55) presented with suspected penile fracture during an 8-year period. One man presented twice. Two of the patients were managed expectantly and the remaining 16 patients underwent 17 immediate surgical explorations. Explorations were performed under general anesthesia, using a circumferential subcoronal incision and degloving of the penile skin. The tunica albuginea of both penile sides as well as the penile urethra were examined for injuries.


METHODS
Medical records were retrospectively reviewed for etiology, symptoms, signs of physical examination, and information on findings of surgical exploration. Data on erectile function, medical treatment for erectile dysfunction, and penile curvature were obtained during follow-up.


RESULTS
In nine of the 17 procedures the tunica albuginea was intact and the only pathological finding was a ruptured dorsal vein. One procedure was negative for both tunical and vascular injury. A tunical tear was detected in the remaining seven procedures. At a mean follow-up of 40 months (range 4-91), five patients required medical treatment for erectile dysfunction, including the two who were managed expectantly, two with a tunical tear, and one with a venous tear.


CONCLUSIONS
Dorsal vein tears may mimic penile fracture. Suggestive findings following trauma to the erect penis prompted exploration for suspected tunica albuginea tear. In less than half of the men was the diagnosis of penile fracture established and treated at surgery.
Bar-Yosef
Yuval
Y
Department of Urology, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. yuvalbary@hotmail.com
Greenstein
Alexander
A
Beri
Avi
A
Lidawi
Ghalib
G
Matzkin
Haim
H
Chen
Juza
J
D000328:Adult; D015331:Cohort Studies; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis / Q000098:blood supply* / Q000293:injuries* / Q000473:pathology; D010808:Physical Examination; D012189:Retrospective Studies; D012421:Rupture; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014680:Veins / Q000293:injuries