Penile Fracture and Trauma Workup

  • Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS   more...
 
Updated: Jun 24, 2011
 

Laboratory Studies

  • Although no specific laboratory studies are required for penile trauma, a standard preoperative laboratory panel should be considered on a case-by-case basis in all patients. This includes the following:
    • Electrolytes
    • Complete blood count
    • Coagulation studies
    • Type and screen
    • Urinalysis
  • Microscopic hematuria should raise suspicion of a possible urethral injury.
  • Urine culture should be considered in those with obvious signs of a urinary tract infection.
Next

Imaging Studies

  • Imaging studies to assess penile trauma are not usually required and should be used with reservation. They increase medical costs and delay definitive therapy. The physical examination findings alone are often used to establish the diagnosis. When the diagnosis is equivocal, surgical exploration is warranted to assess the injury, diagnose the injury, and render appropriate surgical repair. Imaging studies of the penis can be considered when injury is not evident on physical examination; in this case, the radiologic test is used only to confirm a conservative course of nonoperative management.
  • Retrograde urethrography is the only imaging study for which there should be a low threshold of use. Retrograde urethrography should be performed if urethral injury is suspected based on the presence of blood at the meatus, hematuria of any form, dysuria, or urinary retention. The test is easy to perform and inexpensive.
    • Retrograde urethrography: Retrograde urethrogram reveals the extravasation of contrast material from the urethra into the penile soft tissues, indicating urethral injury. It can be performed by insertion of a 12-14F Foley catheter into the fossa navicularis (distal urethra). The Foley balloon is inflated with 1-2 mL of sterile water. Contrast is injected from a 60-mL piston syringe with the penis placed on stretch. Oblique radiographs are taken and the continuity of the urethra is examined. An alternative technique is forgoing placement of a catheter with intubation of the urethral meatus with a piston syringe and injection of contrast directly into the urethra.
    • Penile cavernosography: Penile cavernosography reveals extravasation of contrast material from the corpus cavernosum into the penile soft tissues, indicating an injury of the tunica albuginea. It can be performed by direct injection of 15-70 mL of quarter–to–half-strength nonionic contrast into the uninjured corpora until penile tumescence is achieved. Fluoroscopic images during injection and 10 minutes postinjection reveal filling defects or extravasation. This technique is thought to cause corporal scarring and should be used with reservation. Cavernosography rarely precludes surgical exploration in both penetrating trauma and fracture of the penis. Its use should not delay definitive surgical treatment.
    • Penile magnetic resonance imaging (MRI): An MRI of the penis provides excellent delineation of anatomy and thus can reveal tunical tears and urethral injury. The technique is expensive and time-consuming. Its availability is often limited depending on time of patient presentation and can cause undue delay in definitive surgical management. It is best reserved for patients in whom injury appears absent and who would support nonoperative treatment.
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Contributor Information and Disclosures
Author

Richard A Santucci, MD, FACS  Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, and Société Internationale d'Urologie (International Society of Urology)

Disclosure: Nothing to disclose.

Coauthor(s)

Joshua A Broghammer, MD  Resident Physician, Department of Urology, Wayne State University

Joshua A Broghammer, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, and American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Gamal Mostafa Ghoniem, MD, FACS  Professor of Urology, Chief, Division of Female Urology, Pelvic Reconstructive Surgery, and Voiding Dysfunction, Department of Urology, University of California, Irvine, School of Medicine

Gamal Mostafa Ghoniem, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urogynecologic Society, American Urological Association, International Continence Society, International Urogynaecology Association, and Society of Urodynamics and Female Urology

Disclosure: Astellas Honoraria Speaking and teaching; Coloplasty Consulting fee Board membership; Uroplasty Consulting fee Consulting

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Jong M. Choe, MD, FACS, to the development and writing of this article

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Eggplant deformity.
Small penile fracture involving the right corpus cavernosum.
More severe penile fracture.
Gunshot wound to the penis.
Partial penile amputation.
Repair of partial penile amputation after primary closure (without replantation of penile remnant).
Penile amputation in the initial stage of replantation.
Penile amputation after replantation.
 
 
 
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