Urological Unit, Hospital de Base do Distrito Federal, SHS Quadra 101 Area Especial s/n, 7° andar (Secretaria da Unidade de Urologia), Asa Sul, Brasília, Distrito Federal, 70335-900, Brazil.
Urology Division, Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP), R. Vital Brasil, 251-Cidade Universitária, Campinas, São Paulo, 70335-900, Brazil.
Int J Impot Res. 2020 Jul;32(4):446-454. doi: 10.1038/s41443-019-0199-7. Epub 2019 Sep 24.
Some patients with clinically diagnosed penile fracture actually have a false fracture (no tunica albuginea tear found at surgery). Although previous reports indicate that these patients often do not report hearing a snapping sound (henceforth sound) at injury, there are no studies of the sound's role in this differential diagnosis. To assess if the sound's absence increased the likelihood of intraoperatively diagnosing a false fracture, we retrospectively analyzed 65 consecutive clinically diagnosed penile fracture patients between January 2008 and December 2017, using surgical diagnosis of penile fracture as outcome variable and sound as main predictor, including as covariates age, presentation delay, immediate detumescence after injury, and whether injury occurred during sexual intercourse. Fifty-six patients had penile fracture (86.2%), and most (40, 71.4%) reported the sound, whereas two of the nine patients with false fracture reported the sound (22.2%, p = 0.007, Fisher's exact test). Bayesian logistic regression revealed that the sound was associated with surgical diagnosis of penile fracture (relative odds ratio = 4.25), and the probability of penile fracture fell from 92 to 74% when the sound was not reported among patients injured during intercourse experiencing immediate detumescence. This study followed PROCESS (Preferred Reporting of Case Series in Surgery) guidelines.
一些临床上诊断为阴茎骨折的患者实际上存在假性骨折（手术时未发现白膜撕裂）。尽管之前的报告表明，这些患者在受伤时通常不会报告听到啪的一声（下文简称声音），但目前尚无研究探讨该声音在这种鉴别诊断中的作用。为了评估声音缺失是否会增加术中诊断假性骨折的可能性，我们回顾性分析了 2008 年 1 月至 2017 年 12 月期间连续 65 例临床上诊断为阴茎骨折的患者，以手术诊断的阴茎骨折为结局变量，声音为主要预测因素，包括年龄、就诊延迟、受伤后即刻消退、以及损伤是否发生在性交期间等作为协变量。56 例患者存在阴茎骨折（86.2%），大多数（40 例，71.4%）报告了声音，而 9 例假性骨折患者中有 2 例（22.2%）报告了声音（p=0.007，Fisher 确切检验）。贝叶斯逻辑回归显示，声音与手术诊断的阴茎骨折相关（相对优势比=4.25），当在即时消退的性交中受伤的患者未报告声音时，阴茎骨折的概率从 92%降至 74%。本研究遵循 PROCESS（手术中病例系列报告的首选报告）指南。
