Palagonia Erika, Castellani Daniele, Ronchi Piero, Dell'Atti Lucio, Galosi Andrea B
Department of Urology, Marche Polytechnic University, Ancona, Italy.
Transl Androl Urol. 2021 Aug;10(8):3524-3528. doi: 10.21037/tau-21-333.
Penile dislocation following a traumatic pubic bone fracture is a very rare condition. Only a few cases are reported in the literature and the presentation mechanism is still not completely understood. The impact energy on the pelvis usually causes a displaced fracture with concomitant withdrawal of the pubic bone. The retraction of the pubic bone pulls the penis by its suspensory ligament leading to penile dislocation. We describe a rare case of a "hidden" penis 2 months after a blunt pelvic trauma following a motor vehicle accident. Clinical examination revealed a retracted penile skin. The penis was not visible, neither palpable in the expected position. Micturition took place by dripping urine from the opening of the prepubic skin where urine got trapped in the surrounding skin. He also complained of not having erections. A magnetic resonance imaging that showed invaginated penis, located in the anterior pelvic wall, adjacent to the right inguinal canal. Surgical repair was performed trough an inverted "V" suprapubic incision that allowed exploring the pubic area. The degloved penile shaft was identified and isolated from fibrotic adhesions to the surrounding tissue. The invaginated penile skin that was thin and retracted. The point of fixation was located deeply in the right pubic area where the subcutaneous tissue and skin were firmly attached to a spike of the fractured pubic bone. This adhesion was sharply resected and the penis and its skin were restored in their anatomical position. The suspensory ligament was partially detached. Erection was simulated using saline solution injection into the corpora cavernosa to exclude penile curvature. Postoperative course was uneventful. One year after surgery, the penis had a normal appearance without retraction and sexual function was completely restored. Our case pointed out the importance of genitalia evaluation by practitioners involved in the care of pelvic trauma patients.
创伤性耻骨骨折后阴茎脱位是一种非常罕见的病症。文献中仅报道了少数病例，其发病机制仍未完全明确。作用于骨盆的撞击能量通常会导致耻骨骨折移位并伴有耻骨回缩。耻骨的回缩通过其悬韧带牵拉阴茎，导致阴茎脱位。我们描述了一例机动车事故导致钝性骨盆创伤2个月后出现“隐匿性”阴茎的罕见病例。临床检查发现阴茎皮肤回缩。阴茎不可见，在预期位置也无法触及。排尿时尿液从耻骨前皮肤开口处滴出，尿液积聚在周围皮肤中。患者还主诉无法勃起。磁共振成像显示阴茎内陷，位于骨盆前壁，毗邻右侧腹股沟管。通过倒“V”形耻骨上切口进行手术修复，以便探查耻骨区域。识别出脱套的阴茎体，并将其与周围组织的纤维性粘连分离。阴茎皮肤内陷且变薄。固定点位于右侧耻骨区域深处，皮下组织和皮肤牢固地附着于耻骨骨折的骨尖。锐性切除该粘连，将阴茎及其皮肤恢复到解剖位置。部分离断悬韧带。向海绵体内注射生理盐水模拟勃起以排除阴茎弯曲。术后病程顺利。术后一年，阴茎外观正常，无回缩，性功能完全恢复。我们的病例指出了骨盆创伤患者护理人员进行生殖器评估的重要性。
