Blondeau Alicia, Grandmougin Aurélie, Larose Clément, Mazeaud Charles
Department of Urology, Nancy University Hospital, France.
Department of Radiology, Nancy University Hospital, France.
Case Rep Urol. 2023 Jun 10;2023:5706109. doi: 10.1155/2023/5706109. eCollection 2023.
Penile fracture is a urological emergency, and surgery is usually recommended to prevent complications. However, proximal locations are scarce and not well investigated. We present two rare penile fractures involving the proximal corpora cavernosa with an original conservative strategy to manage this clinical presentation. Twenty-five- and thirty-eight-year-old men with no previous medical history were admitted to the emergency room for penile trauma during sexual intercourse a few months apart. Both presented with "butterfly pattern" ecchymosis with a palpable hematoma on the perineum. They had no hematuria or voiding dysfunction. Ultrasound found a hematoma and a tear of the proximal corpus cavernosum for the younger one. Then, an MRI confirmed a longitudinal fracture of the right corpus cavernosum for the first patient and left for the second, without urethral injury. In agreement with the patients facing this atypical presentation, we proposed a conservative treatment with analgesics, monitoring, and advice to stop sexual activity for three weeks. After six weeks and four weeks, respectively, we performed a clinical evaluation and a second MRI that found no residual tear or hematoma. The IIEF-5 questionnaire was 24/25 and 25/25. The patients were clinically symptom-free at 8 and 11 months of follow-up. Extreme proximal fracture of the corpus cavernosum can be managed conservatively in selected situations. MRI is useful for decision-making by confirming the diagnosis and location to avoid surgery.
阴茎骨折是一种泌尿外科急症，通常建议手术以预防并发症。然而，阴茎近端骨折的情况少见且研究不足。我们报告两例罕见的阴茎近端海绵体骨折，并采用了一种全新的保守策略来处理这种临床表现。两名分别为25岁和38岁且无既往病史的男性，在相隔数月的性交过程中发生阴茎外伤后被送入急诊室。两人均表现为“蝴蝶样”瘀斑，会阴部可触及血肿。他们均无血尿或排尿功能障碍。超声检查发现较年轻患者的近端海绵体有血肿和撕裂。随后，磁共振成像（MRI）证实首例患者右侧海绵体纵向骨折，第二例患者左侧海绵体纵向骨折，均无尿道损伤。经与面临这种非典型表现的患者协商，我们提出采用镇痛药、监测以及建议停止性活动三周的保守治疗方案。分别在六周和四周后，我们进行了临床评估及第二次MRI检查，结果未发现残留撕裂或血肿。国际勃起功能指数-5（IIEF-5）问卷评分分别为24/25和25/25。在随访的8个月和11个月时，患者临床症状消失。在特定情况下，阴茎海绵体极近端骨折可采用保守治疗。MRI有助于通过确认诊断和骨折位置来避免手术，从而为决策提供依据。
