![]() ![]() ![]() Typically the history includes a sexual encounter involving trauma to the erect penis with an audible ‘pop’ or ‘cracking’ sound, pain, and rapid detumescence. ![]() If there is doubt about the diagnosis adjuncts such as imaging may be used. Penile fracture can be diagnosed clinically with history and physical examination. Injury can involve one or both of the corporal bodies and associated simultaneous urethral injuries may also occur. In the Islamic world, instances of penile fracture may be accidentally self-inflicted by bending the erect penis to achieve rapid detumescence, known as taghaandan. Other reported causes include vigorous intercourse, masturbation, falling off a bed, placing an erect penis in underwear and spontaneously fracturing the penis while urinating. Sexual positions like the female partner on top or on all four limbs are associated with higher incidence. Typically it occurs during vigorous heterosexual coitus, whereby a failed attempt at vaginal insertion of the erect penis results in collision with the pubic bone or perineum. They usually result from an abrupt blunt trauma by forceful bending of the erect penis. Penile fractures are usually due to trauma during intercourse but can also occur secondary to non-sexual causes. All three cavernosa and spongiosa are surrounded by Bucks fascia, dartos fascia, and the penile skin. Blood to the corpora cavernosa is supplied by paired deep arteries of the penis (cavernosal arteries), which run in the centre of each corpora cavernosa. This is very elastic relative to tunica albuginea, allowing expansion of the corpus spongiosum for passage of the ejaculate and urine through the urethra. The urethra passes through the corpus spongiosum. Not unexpectedly, the most common site of rupture is ventrolateral at the thinnest aspect, often in the midshaft. However, sudden flexion-based trauma to an already thinned tunica albuginea can result in rupture. During sexual intercourse, the intracorporeal pressure can reach 180mmHg, and the tunica albuginea can withstand values up to 1500mmHg. In the erect state, the tunica albuginea thins to 0.25–0.50mm and is thinnest ventrolaterally. The tunica albuginea encasing the corpora cavernosa is 2mm thick when the penis is flaccid. Proximally, at the base of the penis, these form the crura, which are attached to the ischiopubic rami. Both corpora cavernosa are surrounded by the tunica albuginea, which displays outer longitudinal and the inner circular fibres. Externally, these are all covered by skin. Each corpora is covered by fascial layers containing nerves, lymphatics, and blood vessels. The penile shaft is made up of three erectile tissues: the two corpora cavernosa and a corpus spongiosum. Concomitant urethral injury has been reported as high as 38% of cases, although the largest USA series suggests a lower rate of 23%. Annual incidence in the USA is estimated at 500–600 cases, responsible for one in every 175,000 emergency admissions. It occurs more frequently in Middle Eastern and North African countries (almost 55% of the total number reported) than in the United States or Europe (almost 30% of those reported). It is not an uncommon condition but is often underreported. Penile fracture was reported for the first time by Abul Kasem, an Arab physician, in Cordoba, Spain more than 1000 years ago. This may be associated with corpus spongiosum or urethral injury. Traumatic rupture of the tunica albuginea with either one or both corpora cavernosa of the penis is known as penile fracture. ![]()
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