Ettanji A, Hannaoui A, Bencherki Y, Dakir M, Debbagh A, Aboutaieb R
Department of Urology, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy in Casablanca, Morocco.
Department of Urology, Ibn Rochd University Hospital Center, Casablanca, Morocco; Faculty of Medicine and Pharmacy in Casablanca, Morocco.
Int J Surg Case Rep. 2021 Mar;80:105665. doi: 10.1016/j.ijscr.2021.105665. Epub 2021 Mar 1.
Traumatic lesions of the anterior urethra during coitus strikes are essentially described as lesions associated with 20 percent of corpus cavernosum fractures. However, no cases of isolated lesions of the urethra and corpus spongiosum in the context of sexual trauma seem to be reported in the literature. Thus, we report the observation of a patient who was diagnosed with a corpus spongiosum fracture associated with a penile urethra injury during a coitus lapse.
Patient aged 36 years with no particular pathological history, other than unprotected sexual intercourse, who has been admitted to the urology service for urethrorrhagia due to a sexual traumatism. A forced angulation and then a cracking followed by an instantaneous detumescence was described by the patient. On examination we noted a normal-looking penis without angulation or eggplant haematoma, with the presence on palpation of a small infra-centimetric hematoma on the ventral surface of the middle part of the penis. Surgical exploration was therefore indicated in front of the isolated urethrorrhagia, and which objectified a fracture of the corpus spongiosum measuring 1 cm at the level of the distal part of the penis. A linear lesion of the urethra was associated at the same level. The patient was therefore sutured with these two lesions. The postoperative course was simple with removal of the bladder catheter three weeks later with satisfactory urination and urinary stream.
sexual trauma is described as a rupture of the corpora cavernosa, resulting from forced flexion or twisting of the erect penis that can be associated in about 20 % of cases with ruptures of the urethra. We described a trauma occurrence that is similar to the one in the definition responsible of a lesion of the anterior urethra but no lesions of the corpora cavernosa have been objectified.
the absence of similar cases reported in the literature leaves this type of lesion subject to ambiguous behaviour. Indeed, this brings us back to questions about the pathophysiological mechanisms of sexual lesions of the urethra in order to better codify the indication for surgical exploration, even in front of a normal looking penis.
性交时发生的前尿道创伤性损伤本质上被描述为与20%的海绵体骨折相关的损伤。然而，文献中似乎没有报道过性创伤情况下尿道和海绵体孤立损伤的病例。因此，我们报告一例在性交失误时被诊断为海绵体骨折合并阴茎尿道损伤的患者。
一名36岁患者，无特殊病史，除有不安全性行为外，因性创伤导致尿道出血入住泌尿外科。患者描述阴茎先是被迫成角，随后出现爆裂声，紧接着立即消肿。检查时，我们发现阴茎外观正常，无成角或茄子样血肿，触诊时在阴茎中部腹侧发现一个小于1厘米的小血肿。鉴于孤立性尿道出血，因此有必要进行手术探查，结果发现阴茎远端水平处海绵体骨折，长度为1厘米。同一水平处伴有尿道线性损伤。因此对患者的这两处损伤进行了缝合。术后过程顺利，三周后拔除膀胱导管，排尿及尿流情况良好。
性创伤被描述为海绵体破裂，是由勃起阴茎的强迫弯曲或扭转引起的，约20%的病例可能伴有尿道破裂。我们描述的创伤情况与前尿道损伤定义中的情况相似，但未发现海绵体损伤。
文献中未报道过类似病例，使得这种类型的损伤处理存在不确定性。确实，这让我们重新思考尿道性损伤的病理生理机制问题，以便更好地规范手术探查的指征，即使在阴茎外观正常的情况下。
