Editorial Comment: Diagnostic performance of MRI and US in suspicion of penile fracture

Favorito, Luciano A.

doi:10.1590/S1677-5538.IBJU.2023.03.03

Paul Spiesecke ¹ 1 Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; , Josef Mang ² 2 Department of Urology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany , Thomas Fischer ¹ 1 Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; , Bernd Hamm ¹ 1 Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; , Markus H Lerchbaumer ¹ 1 Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Transl Androl Urol. 2022 Mar;11(3):377-385.

COMMENT

Penile fracture(PF) is a type of penile trauma that requires emergency intervention (¹1. Koifman L, Cavalcanti AG, Manes CH, Filho DR, Favorito LA. Penile fracture - experience in 56 cases. Int Braz J Urol. 2003;29:35-9.

2. Kamdar C, Mooppan UM, Kim H, Gulmi FA. Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome. BJU Int. 2008;102:1640-4; discussion 1644.-³3. Patil B, Kamath SU, Patwardhan SK, Savalia A. Importance of time in management of fracture penis: A prospective study. Urol Ann. 2019;11:405-9.). PF is defined as the rupture of the tunica albuginea (TA) of the corpora cavernosa (CC) caused by blunt trauma to the erect pênis. In most cases, that occurs during sexual relations, when the penis slips out of the vagina and strikes against the symphysis pubis or perineum and is more likely when the partner is on top (⁴4. Barros R, Silva M, Antonucci V, Schulze L, Koifman L, Favorito LA. Primary urethral reconstruction results in penile fracture. Ann R Coll Surg Engl. 2018;100:21-5.

5. Barros R, Schulze L, Ornellas AA, Koifman L, Favorito LA. Relationship between sexual position and severity of penile fracture. Int J Impot Res. 2017;29:207-9.-⁶6. Barros R, Guimarães M, Nascimento C Jr, Araújo LR, Koifman L, Favorito LA. Penile refracture: a preliminary report. Int Braz J Urol. 2018;44:800-4.).

The diagnosis of penile fracture is mainly clinical, made from a thorough history and physical exam alone (⁷7. Muentener M, Suter S, Hauri D, Sulser T. Long-term experience with surgical and conservative treatment of penile fracture. J Urol. 2004;172:576-9.

8. Sokolakis I, Schubert T, Oelschlaeger M, Krebs M, Gschwend JE, Holzapfel K, et al. The Role of Magnetic Resonance Imaging in the Diagnosis of Penile Fracture in Real-Life Emergency Settings: Comparative Analysis with Intraoperative Findings. J Urol. 2019;202:552-7.-⁹9. Spiesecke P, Mang J, Fischer T, Hamm B, Lerchbaumer MH. Diagnostic performance of MRI and US in suspicion of penile fracture. Transl Androl Urol. 2022;11:377-85.). The patient often reports blunt trauma during intercourse accompanied by an audible “snap” or “pop,” followed by immediate pain and rapid detumescence. Physical exam findings may include edema, ecchymosis, and penile deformity, classically described as an “eggplant deformity” (¹1. Koifman L, Cavalcanti AG, Manes CH, Filho DR, Favorito LA. Penile fracture - experience in 56 cases. Int Braz J Urol. 2003;29:35-9.).

In the present paper the authors studied the further evidence concerning the diagnostic accuracies of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnostic assessment of patients with suspected PF and concluded that the results of this study suggest that MRI is more suitable to confirm PF and identify the site of the associated tunica albuginea tear while US is a good tool for ruling out PF.

REFERENCES

¹
Koifman L, Cavalcanti AG, Manes CH, Filho DR, Favorito LA. Penile fracture - experience in 56 cases. Int Braz J Urol. 2003;29:35-9.
²
Kamdar C, Mooppan UM, Kim H, Gulmi FA. Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome. BJU Int. 2008;102:1640-4; discussion 1644.
³
Patil B, Kamath SU, Patwardhan SK, Savalia A. Importance of time in management of fracture penis: A prospective study. Urol Ann. 2019;11:405-9.
⁴
Barros R, Silva M, Antonucci V, Schulze L, Koifman L, Favorito LA. Primary urethral reconstruction results in penile fracture. Ann R Coll Surg Engl. 2018;100:21-5.
⁵
Barros R, Schulze L, Ornellas AA, Koifman L, Favorito LA. Relationship between sexual position and severity of penile fracture. Int J Impot Res. 2017;29:207-9.
⁶
Barros R, Guimarães M, Nascimento C Jr, Araújo LR, Koifman L, Favorito LA. Penile refracture: a preliminary report. Int Braz J Urol. 2018;44:800-4.
⁷
Muentener M, Suter S, Hauri D, Sulser T. Long-term experience with surgical and conservative treatment of penile fracture. J Urol. 2004;172:576-9.
⁸
Sokolakis I, Schubert T, Oelschlaeger M, Krebs M, Gschwend JE, Holzapfel K, et al. The Role of Magnetic Resonance Imaging in the Diagnosis of Penile Fracture in Real-Life Emergency Settings: Comparative Analysis with Intraoperative Findings. J Urol. 2019;202:552-7.
⁹
Spiesecke P, Mang J, Fischer T, Hamm B, Lerchbaumer MH. Diagnostic performance of MRI and US in suspicion of penile fracture. Transl Androl Urol. 2022;11:377-85.

Publication Dates

Publication in this collection
05 June 2023
Date of issue
May-Jun 2023

History

Received
25 Mar 2023
Accepted
05 Apr 2023
Published
15 Apr 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Koifman L, Cavalcanti AG, Manes CH, Filho DR, Favorito LA. Penile fracture - experience in 56 cases. Int Braz J Urol. 2003;29:35-9.

[2] ²
Kamdar C, Mooppan UM, Kim H, Gulmi FA. Penile fracture: preoperative evaluation and surgical technique for optimal patient outcome. BJU Int. 2008;102:1640-4; discussion 1644.

[3] ³
Patil B, Kamath SU, Patwardhan SK, Savalia A. Importance of time in management of fracture penis: A prospective study. Urol Ann. 2019;11:405-9.

[4] ⁴
Barros R, Silva M, Antonucci V, Schulze L, Koifman L, Favorito LA. Primary urethral reconstruction results in penile fracture. Ann R Coll Surg Engl. 2018;100:21-5.

[5] ⁵
Barros R, Schulze L, Ornellas AA, Koifman L, Favorito LA. Relationship between sexual position and severity of penile fracture. Int J Impot Res. 2017;29:207-9.

[6] ⁶
Barros R, Guimarães M, Nascimento C Jr, Araújo LR, Koifman L, Favorito LA. Penile refracture: a preliminary report. Int Braz J Urol. 2018;44:800-4.

[7] ⁷
Muentener M, Suter S, Hauri D, Sulser T. Long-term experience with surgical and conservative treatment of penile fracture. J Urol. 2004;172:576-9.

[8] ⁸
Sokolakis I, Schubert T, Oelschlaeger M, Krebs M, Gschwend JE, Holzapfel K, et al. The Role of Magnetic Resonance Imaging in the Diagnosis of Penile Fracture in Real-Life Emergency Settings: Comparative Analysis with Intraoperative Findings. J Urol. 2019;202:552-7.

[9] ⁹
Spiesecke P, Mang J, Fischer T, Hamm B, Lerchbaumer MH. Diagnostic performance of MRI and US in suspicion of penile fracture. Transl Androl Urol. 2022;11:377-85.

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