Sexual happiness "fold" learning, "banana" emergency moment

Author: Wang Jin, Wuhan Union Hospital

Reviewer: Peng Jing, Chief Physician, Peking University First Hospital

Penile "fracture", i.e. rupture of the tunica albuginea of ​​the penis, is a relatively rare but serious tissue injury in male urological emergencies. It often occurs during sexual intercourse. Since it may affect men's future erections, patients need to go to the hospital for diagnosis and treatment in time to avoid delaying the best time to seek medical treatment.

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1. Why does the penis get “broken”?

The normal male penis maintains an erection by relying on two spongy bodies similar to inflatable rods. Its surface is covered with a tough white membrane, which supports the penis when it is erect and feels like cartilage. It will naturally become flaccid when the congestion in the penis disappears.

When the penis is flaccid, the thickness of the tunica albuginea is about 2 mm, and it is not easy to be injured or "broken". However, when the penis is erect, the cavernous body cavity is filled with a lot of blood, which makes the penis thicker and harder, and the tunica albuginea also increases and becomes thinner (thickness is 0.25-0.50 mm), with reduced elasticity and increased brittleness. At this time, if the penis is suddenly subjected to strong external force, it is easy to cause damage to the cavernous body or rupture of the tunica albuginea, which in turn causes congestion and swelling of the penis or other adjacent parts, with symptoms similar to fractures.

Common external forces that can cause penile "fractures" include violent sexual intercourse, improper sexual postures, excessive masturbation, and masturbation with special equipment. Studies have shown that 43% to 55% of penile "fractures" are caused by improper sexual intercourse, and 8% to 24% are caused by masturbation. Occasionally, patients suffer from penile "fractures" due to collision with hard objects, falling out of bed, or falling during erection [1].

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2. Clinical manifestations and diagnosis of penile "fracture"

When the penis is "fractured", the patient may feel sudden severe pain and may also hear a crisp sound. The specific clinical manifestations are:

1. Pain

Patients often have a tearing sensation and severe local pain at the injured site, which sometimes radiates to the external urethral opening.

2. Local hematoma

Since the degree of penile "fracture" varies, some hematomas are limited to the penis, showing eggplant sign (swelling, bruising); some hematomas may appear in other parts besides the penis, such as perineum, scrotum, and even swelling, ecchymosis and butterfly-shaped hematoma (butterfly sign) of the lower abdominal wall. During palpation, doctors can often find a clear, fixed, isolated mass under the skin of the penis, which is the rupture of the tunica albuginea.

3. Curvature deformity

The swollen penis tends to lean towards the healthy side, but it may also bend downward and become deformed, like a fish hook.

4. Hematuria or difficulty urinating

If the tunica albuginea ruptures and the urethra is damaged, the patient will experience some symptoms of urethra damage, such as hematuria or difficulty urinating.

3. Diagnosis of Penile Fracture

In clinical practice, doctors often need to use imaging examinations to confirm the specific conditions of patients with penile "fractures" in order to take targeted treatment measures.

Color Doppler ultrasound

Color Doppler ultrasound is a non-invasive examination that is low-cost, simple and easy to perform. It can not only detect the rupture of the corpus cavernosum and observe the scope of the rupture of the tunica albuginea, but also detect the blood flow in the corpus cavernosum. It is the preferred method for diagnosing penile "fracture". However, when the rupture of the tunica albuginea is small and B-ultrasound may not be easy to detect, magnetic resonance imaging or penile corpus cavernosum angiography is needed to make a diagnosis.

Magnetic resonance imaging

Magnetic resonance imaging can accurately show the location and range of rupture of the tunica albuginea, and distinguish rupture of the tunica albuginea from penile hematoma caused by rupture of the deep dorsal artery or vein of the penis. It is a reliable method for diagnosing rupture of the tunica albuginea of ​​the penis, but it is expensive and difficult to be widely used in clinical practice. Therefore, it is currently only used to clarify rupture of the tunica albuginea and corpus cavernosum injury that is highly suspected clinically but cannot be diagnosed by B-mode ultrasound and has no obvious symptoms.

Cavernosography

Penile corpus cavernosum radiography can detect the site of rupture of the tunica albuginea and the range of the fissure, but it is an invasive examination. Extravasation of contrast agent can cause severe fibrosis of the corpus cavernosum and affect penile erection, and it can have a high false positive rate. Therefore, it has gradually been replaced by B-type ultrasound and magnetic resonance imaging.

Urinary tract imaging

If urinalysis shows macroscopic or microscopic hematuria and urethral injury is suspected, urography is required to confirm the extent of urethral injury [1].

Treatment of Penile Fracture

The treatment method of penile tunica albuginea rupture is directly related to the degree of injury, and early emergency surgical repair of the tunica albuginea rupture is currently the preferred and most effective treatment method that can reduce complications.

1. Emergency treatment

Local cold compress can prevent the hematoma from expanding. For patients with heavy bleeding and shock symptoms, anti-shock treatments such as infusion, blood transfusion, analgesia and sedation can be given.

2. Non-surgical treatment

It is suitable for patients with small tunica albuginea rupture, mild hematoma, corpus cavernosum damage but intact tunica albuginea. The main treatment measures include local pressure bandage, cold compress, sedation and analgesia, and antibiotics to prevent infection. However, it has many complications. 10% to 53% of patients will experience enlargement of penile hematoma, secondary infection, penile fibrosis, painful nodules, angular deformity, arteriovenous fistula, penile induration, corpus cavernosum fibrosis, and penile erectile dysfunction.

3. Surgery

Patients with bleeding or swelling or suspected urethral injury should undergo surgical treatment in a timely manner to reduce complications and shorten recovery time.

For patients with clear injury sites, we can choose to make an incision at the injured part of the penis, expose the ruptured tunica albuginea layer by layer, and then suture the tunica albuginea with absorbable sutures.

For patients with an unknown injury site and a large hematoma, it is best to make a circular incision below the coronal sulcus, remove the deep surface of the penile deep fascia to the base of the penis, fully expose the rupture of the tunica albuginea, and suture the ruptured tunica albuginea with absorbable sutures after the hematoma is removed. When there is urethral injury, the urethra can be repaired by suture in layers to avoid the urethral injury site and the circular incision being in the same plane, otherwise it may cause urinary fistula[1].

After the operation, the patient needs to abstain from sexual intercourse for at least one month to allow the penis to fully rest and recover. Usually, if the penis "fracture" is treated promptly, there will generally be no obvious sequelae.

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Penile "fracture" is not inevitable. In addition to developing good sexual habits, men should also act within their means during sexual intercourse and fully perform "foreplay" and lubricate their genitals before engaging in intercourse.

References

Xia Shujie, Lü Futai, Xin Zhongcheng. Guo Yinglu's Andrology[M]. 2nd edition. Beijing: People's Medical Publishing House, 2019.