Approach And Management Of Penılle Fracture Patıents Applyıng To The Emergency Department

Öz

INTRODUCTION Penile fracture is one of the rare urological emergencies, but it needs attention (1). Most penile fractures are caused by direct trauma during sexual intercourse. Direct trauma to an erect penis results in increased pressure in the cavernosa. This increased pressure causes the tunica albuginea to rupture. Penile fracture most commonly seen during sexual intercourse in Western societies; In the Middle East and Gulf countries, it is seen at a rate of 65% due to the "taqaandan" (or taghaandan) maneuver (2,12). Although the history and physical examination have an important place in the diagnosis, difficulties may be encountered. Our aim in this study is to share our clinical experience and contribute to the literature. METHODS Thirty patients who applied to Pamukkale University Medical Faculty Emergency Service between 2009-2022 were evaluated retrospectively. The patients' age, presentation complaints, physical examination findings, duration of admission to the emergency department, radiological imaging procedures, surgical findings performed by the urology, whether there was any accompanying urethral injury, and the location of the fracture detected in the radiological examinations of the patients and the compatibility of the fracture detected during surgery were evaluated. RESULTS The mean age of the patients was 42.5±14.2 years. The rate of admission to the emergency department within the first 6 hours was 56.5%. It was observed that the cause of penile fracture was during the sexual history in 56.5%, and the most common physical examination finding was penile hematoma with a rate of 87%. The success rate of penile Doppler ultrasonography in clearly evaluating the presence of penile fracture was found to be 39.1%. CONCLUSIONS The most common cause of penile fracture is sexual intercourse, and the diagnosis is made by typical anamnesis and physical examination. Physical examination, ultrasonography, and if there is doubt, magnetic resonance imaging guides the diagnosis.

Anahtar Kelimeler

• Penile Fracture
• Trauma
• Urethral Injury
• Penile Fracture, Trauma, Urethral Injury

Acil Servise Başvuran Penil Fraktür Hastalarinda Yaklaşım ve Yönetim

Öz

AMAÇ Penil fraktür nadir ancak dikkat edilmesi gereken ürolojik acillerdendir (1). Penil fraktürlerin çoğu cinsel ilişki sırasında doğrudan travma ile oluşur. Ereksiyon halindeki bir penise doğrudan travma, kavernozada artan basınçla sonuçlanır. Bu artan basınç, tunika albuginea'nın yırtılmasına neden olur. Batı toplumlarında en sık cinsel ilişki sırasında ve pozisyona bağlı riskin arttığı erekte peniste görülen penil fraktür ; ortadoğu, körfez ülkelerinde “taqaandan” ( ya da taghaandan) manevrası kaynaklı %65 oranında görülmektedir(2,12). Tanıda hikâye ve fizik muayene önemli bir yere sahip olmakla beraber zorluklar ile karşılaşılabilmektedir. Bu çalışmadaki amacımız klinik deneyimlerimizi literatür eşliğinde paylaşmak ve literatüre katkıda bulunmaktır. ÇALIŞMA PLANI 2009-2022 Yılları arasında Pamukkale üniversitesi tıp fakültesi hastanesi acil servisine penil fraktür ön tanısı ile başvuran 30 hasta retrospektif olarak değerlendirildi. Hastaların yaş, başvuru şikayetleri, fizik muayene bulguları, acile başvuru süreleri, radyolojik görüntüleme işlemleri, üroloji tarafından uygulanan cerrahi bulguları, üretral yaralanmanın eşlik edip etmediği ve hastalara yapılan radyolojik tetkiklerde saptanan fraktürün yeri ile cerrahi sırasında saptanan fraktürün uyumu değerlendirildi. BULGULAR Hastaların yaş ortalaması 42.5±14,2 yıl, acil servise ilk 6 saat içinde başvuru oranları %56,5 olarak saptanmıştır. Penil fraktür nedeninin %56,5 cinsel öykü sırasında olduğu, en sık fizik muayene bulgusunun ise %87 oranında penil hematom olduğu görülmüştür. Penil doppler ultrasonografinin penil fraktür varlığını net değerlendirme başarısı %39,1 olarak saptanmıştır. SONUÇ Penil fraktürün en sık nedeni cinsel ilişki olup, tanı tipik anamnez ve fizik muayene ile konulmaktadır. Fizik muayene, ultrasonografi ve şüphe var ise manyetik rezonans görüntüleme tanı koymada yol göstericidir.

Anahtar Kelimeler

• Penil Fraktür
• Travma
• Üretral İnjury
• Penil Fraktür, Travma, Üretral İnjury

Kaynakça

1. 1. Diaz KC, Cronovich H. Penis Fracture. [Updated 2021 May 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551618/
2. 2. De Luca, Francesco, et al. "Functional outcomes following immediate repair of penile fracture: a tertiary referral centre experience with 76 consecutive patients." Scandinavian Journal of Urology 51.2 (2017): 170-175.
3. 3. Tarik Amer, Rebekah Wilson, Piotr Chlosta, Salah AlBuheissi, Hasan Qazi, Michael Fraser, Omar M. Aboumarzouk. Penile Fracture: A Meta-Analysis. Urol Int 2016;96:315–329
4. 4. Koifman L, Barros R, Júnior RA, Cavalcanti AG, Favorito LA: Penile fracture: diagnosis, treatment and outcomes of 150 patients. Urology 2010; 76: 1488–1492.
5. 5. Aaronson DS, Shindel AW. U.S. national statistics on penile fracture. J Sex Med. 2010;7:3226.
6. 6. Mydlo JH. Surgeon experience with penile fracture. J Urol 2001;166:526-8.
7. 7. Daniel E. W. Swanson, A. Scott Polackwich, Brian T. Helfand, Puneet Masson, James Hwong, Daniel D. Dugi III. Penile Fracture: Outcomes of Early Surgical Intervention. UROLOGY 2014;84(5):1117-21.
8. 8. Zargooshi J. Penile fracture in Kermanshah, Iran: report of 172 cases. J Urol 2000;164:364-6

9. 9. Eke N. Fracture of the penis. Br J Surg 2002;89:555-65.
10. 10. Choi MH, Kim B, Ryu JA, Lee SW, Lee KS. MR imaging of acute penile fracture. Radiographics 2000;20:1397-405
11. 11. Ahmadnia H, Younesi Rostami M, Kamalati A, Imani MM: Penile fracture and its treatment: is retrograde urethrograghy necessary for management of penile fracture? Chin J Traumatol 2014; 17: 338–340.
12. 12. El-sherif AE, Daulents M, Allowneh N, et all. Management of fracture of the penis in Qatar. Br J Urol 1991;68:622-5.
13. 13. Dell'Atti L, Scarcella S, Argalia G, et al. Rupture of the cavernous body diagnosed by contrast-enhanced ultrasound: Presentation of a clinical case. Arch Ital Urol Androl. 2018; 90:143-144.
14. 14. Salonia A, Bettocchi C, Carvalho, et al. Guidelines Associates: EAU Sexual and Reproductive Halt Guidelines 2020.
15. 15. Yamaçake KG, Tavares A, Padovani GP, et al. Long-term Treatment Outcomes Between Surgical Correction and Conservative Management for Penile Fracture: Retrospective Analysis. Korean J Urol. 2013; 54:472-76.
16. 16. Gamal WM, Osman MM, Hammady A, et al. Penile fracture: long-term results of surgical and conservative management. J Trauma. 2011; 71:491-93.,
17. 17. Panella, Paolo, Pietro Pepe, and Michele Pennisi. "Diagnosis and treatment of penile injury: Ten years experience of an emergency department." Archivio Italiano di Urologia e Andrologia 92.3 (2020).
18. 18. Bella AJ, Shamloul R. Addressing the barriers to optimal management of penile fracture. Can Urol Assoc J 2013;7:258–