![]() ![]() 6, 7 With delayed presentation, he found there were no further difficulties in identifying the injury site and no increased rates of complications, including ED. Alternatively, Zargooshi performed a large, retrospective analysis in which patients were treated with surgical repair regardless of any delay in presentation. Karadeniz et al 4 and Gottenger and Wagner 5 reported that the delay between injury and surgery was linked to higher rates of complications. Further, preoperative imaging with ultrasound or magnetic resonance imaging (MRI) may allow for a reduction in negative explorations and more precise planning of the repair. 1 A delay may allow for medical optimization of the patient prior to surgery, reduced tissue edema, and the demarcation of healthy and necrotic tissue. From a logistical perspective, a delayed repair may allow for the case to be deferred to a more specialized surgeon with more experience of the relevant anatomy, as well as minimized disruption to surgeon and hospital scheduling. Delayed repair of penile fracture may occur due to delayed presentation after initial injury, surgeon preference, or in patients who initially select conservative management. Thus, surgical repair showed clear benefits over conservative management and this has been confirmed in other studies.Īlthough immediate surgery is advocated, timing of penile fracture repair can either be early (less than 24 hours from injury to presentation/surgery) or delayed (greater than or equal to 24 hours). 2 Fewer complications were seen with patients managed surgically, with 88.6% reporting sufficient erections for intercourse with no voiding dysfunction or penile curvature compared to 66.7% of those managed conservatively. In a retrospective study by Yamicake et al, 42 patients with penile fracture presented over an eight-year period to their centre, with 35 managed surgically and six conservatively. Immediate surgical repair is the current standard of care with lower risks of complications, including erectile dysfunction (ED), penile curvature, and tunical scar formation, compared to conservative management. 1 At the time of injury, patients often describe an audible snap, followed immediately by penile detumescence and pain. Penile fractures occur after traumatic rupture of the tunica albuginea of one or both corpora cavernosa, typically when the penis is erect during rigorous sexual activity, masturbation, or penile manipulation. Ultrasonography is easy and helpful however, the more invasive cavernosography and/or magnetic resonance imaging are indicated when the case is atypical, or the diagnosis of rupture of tunica is suspicious.Penile fractures are classically recognized as a urological emergency requiring immediate surgical intervention. There is a low incidence and degree of erectile dysfunction among repaired patients however, it should be thoroughly investigated and properly managed. We conclude that the excellent outcome of our patients parallels other reports of early surgical repair regarding low morbidity, short hospital stay and rapid functional recovery. Psychosexual consultation was required for two of these patients while the third was successfully managed by self-ICI of PGE 1 Intracavernous injection (ICI) of PGE 1 and penile duplex Doppler showed a normal pattern in three patients with erectile dysfunction while the fourth showed incompetent veno-occlusive mechanism. Delayed complications were detected in only six cases (12.2%) in the form of mild penile curvature on erection, plaques and/or mild erectile dysfunction. ![]() Interrupted absorbable sutures were used for repair in most of the patients. All tunica albuginea ruptures were unilateral except one case which was bilateral. Immediate exploration was done using subcoronal circumferential incision in about two-thirds of the cases. Penile ultrasonography was used to confirm the diagnosis in 23 patients. Only five patients had accompanying urethral rupture. Patients reporting decreased erectile function were further assessed by evaluating their response to intracavernous injection of PGE 1 and by penile color duplex Doppler ultrasonography.Īll of our patients had the classic clinical presentation of penile swelling and ecchymosis. Forty-nine patients were followed up regarding penile curvatures, plaques and erectile function. The data of 60 patients admitted to Mansoura Urology and Nephrology Center with penile fractures and treated by immediate surgical repair were reviewed with respect to their presentation, investigations, operative and post-operative details. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |