Hospital: Complejo asistencial universitario de León.
Nº: C2019-217
Aut@r o Autores: M. Pérez Rodríguez, A. Pérez Termenón, F. Somalo Alfaro, I. López García, J. López Fernández, A. Fernández Martínez.
Presentación
A 41-year-old man, presented with sudden pain during intercourse. He heard a snapping sound during sexual intercourse and immediately loss of erection. Physical examination revealed a swollen penile and blood on the urethral meatus. In the left side of penile was identified a haematoma. Ultrasound examination demonstrated a focal interruption of tunica albuginea of 4 mm and a hypoecogenic colection adjacent to left corpora cavernosa, suggestive of penile haematoma. In Doppler color examination, blood flow in left cavernosal artery was detected, identifying blood leaks out of corpora cavernosa through the disruption, compatible with active arerial bleeding. These findings were suggestive of diruption on left corpora cavernosa.
Discusión
Fracture of the penis is the rupture of the tunica albuginea of the corpus cavernosa. Most blunt traumatic injuries occurs during intercourse and clinically consists in sudden pain, penile deformity, swelling and detumescence. Penile urethra lesions occur at least twent per cent of cases, often clinically present dysuria and blood at the urethral meatus. If the tear extends to involve Buck's Fascia, the blood leak can spread to involve the scrotm, perineum and lower adbominal wall. Ultrasound is an innocuous examination and easily accessible with high sensibility to penile fracture diagnosis, that helps in prompt diagnosis and timely surgical repair of the fractured penis. Ultrasound examination identifies local interrupcions in tunica albuginea which are showed as hipecoic areas with blood leaks to subcutaneuous plane causing penis haematoma. It is important to evaluate the integrity of tunica albuginea to realise a differential diagnosis of penile fracture an intra-cavernosal haematoma.
Conclusión
Penile fracture is an urological emergency. The differencial diagnosis among penile fracture and intra-cavernosal haematoma is based in ultrasound examination that can provide prompt and non-invasive diagnosis, and helps out to evaluate the integrity of tunica albuginea. Treatment recommendations for penile fractures are immediate surgical exploration.
Bibliografía
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