Penile Fracture and Trauma Workup

Updated: Dec 30, 2015
  • Author: Richard A Santucci, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Workup

Laboratory Studies

See the list below:

  • 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.
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Imaging Studies

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  • 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. [11]
  • 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. [12]
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