Lorenzo Romero J G, Segura Martín M, Salinas Sánchez M, Pastor Guzmán J M, Hernández Millán I, Martínez Martín M, Virseda Rodríguez J A
Servicio de Urología, Hospital General de Albacete.
Actas Urol Esp. 1999 Jul-Aug;23(7):635-9.
The traumatic rupture of cavernous bodies is an uncommon condition that always takes place with an erected penis, the most frequent etiology being an untimely vaginal intercourse, due to the greater vulnerability of the penis in such situation, resulting from contained trauma by direct external forces. The distinctive presenting signs are a "snap", immediate detumescence, pain, deformity, bruise and deviation contralateral to the lesion. The bruises will be limited to the penis in the presence of Buck's fascia integrity. This paper contributes one case of rupture of right cavernous body, explaining its typical etiology, signs and symptoms, and examination of the patients who underwent emergency surgery.
27-year-old patient who turns up into the emergency service with penile haematoma and local pain, reporting an earlier snap and detumescence. The examination reveals a hose-type haematoma with a "wringer" mark. The ultrasound shows haematoma, albuginea interruption and Buck's fascia integrity. The patient undergoes emergency surgery that involves whole penis denudation, haematoma evacuation and suture of impaired cavernous body. No incidence is reported during the post-operative. The patient is now asymptomatic and holds successful erections.
The differential diagnosis should be done versus rupture of the penis dorsal vein, which causes identical signs and symptoms. NMR is considered as the best imaging test, although is still quite unaffordable. Standard ultrasounds do not rule out the diagnosis. Under suspicion of associated urethral damage, retrograde urethrography is warranted. Cavernosonography has very specific indications and should be avoided whenever possible. Choice treatment will be emergency revision and surgical repair. Suture of involved cavernous body must be done with loose stitches of absorbable material. Antibiotic prophylaxis is indicated in cases of concomitant urethral involvement.
海绵体创伤性破裂是一种罕见情况，通常发生在阴茎勃起时，最常见的病因是性交时机不当，因为在这种情况下阴茎更容易受到伤害，是由直接外力造成的创伤所致。其独特的表现体征为“啪”的一声、阴茎立即疲软、疼痛、畸形、瘀伤以及与损伤部位对侧的阴茎偏斜。若白膜完整，瘀伤将仅限于阴茎。本文报告一例右侧海绵体破裂病例，阐述其典型病因、体征和症状，以及对接受急诊手术患者的检查情况。
一名27岁患者因阴茎血肿和局部疼痛前来急诊，称之前有过“啪”的一声及阴茎疲软情况。检查发现呈软管状血肿并有“绞拧”痕迹。超声显示有血肿、白膜中断且白膜完整。该患者接受了急诊手术，包括阴茎完全剥脱、血肿清除以及受损海绵体缝合。术后未出现并发症。患者目前无症状，勃起功能正常。
应与阴茎背静脉破裂进行鉴别诊断，二者症状体征相同。核磁共振成像（NMR）被认为是最佳影像学检查，尽管费用仍然很高。标准超声不能排除诊断。怀疑有尿道损伤时，需进行逆行尿道造影。海绵体造影有非常特殊的适应证，应尽可能避免使用。首选治疗方法是急诊修复和手术修补。对受累海绵体进行缝合时，必须使用可吸收材料的宽松缝线。伴有尿道损伤时需使用抗生素预防感染。
