Department of Radiology, University College London Hospital, London NW12BU, United Kingdom.
Division of Surgery and Interventional Science, University College London, London WC1E 6BT, United Kingdom.
Br J Radiol. 2024 Nov 1;97(1163):1850-1855. doi: 10.1093/bjr/tqae167.
The primary objective is to compare the imaging and surgical findings in a cohort of patients with suspected penile fracture (PF).
Retrospective cohort study of all patients with suspected PF over an 11-year period at a tertiary referral andrology centre. All dedicated presurgical imaging with ultrasound (US) and MRI was analysed and correlated with intraoperative findings; alternative diagnoses were recorded.
One hundred and ninety-three patients were included. One hundred and four (54%) had alternative diagnoses to PF including dorsal vein rupture and haematoma. Ninety-nine (51%) underwent surgical exploration of which 89 (46%) had PF. US correctly confirmed the presence and marked the site of fracture in 92% of cases. MRI was primarily used as a problem-solving tool (13 cases) and demonstrated a more extensive injury than US (12 cases). The reported size of tunical defect on imaging was a median of 7 mm (IQR 4-10) significantly smaller than on exploration (median 20 mm, IQR 10-30; P < .0001).
US has a high positive predictive value in the confirmation of PF. MRI improves the detection and characterizing the extent of injury. Imaging marking informs surgical incision but defect size is under appreciated on all imaging modalities.
Penile imaging has a high positive predictive value to not only confirm the diagnosis of PF but to stage the extent of injury and mark the skin, which impacts the surgical technique. Alternative diagnoses to fracture are common and imaging could prevent unnecessary surgical exploration.
本研究旨在比较疑似阴茎骨折（PF）患者的影像学和手术发现。
回顾性分析了 11 年来在一家三级转诊男科中心就诊的所有疑似 PF 患者的资料。所有患者均行超声（US）和 MRI 等专门的术前影像学检查，并与术中发现进行了相关性分析；同时记录了其他诊断。
共纳入 193 例患者。104 例（54%）患者存在 PF 以外的其他诊断，包括阴茎背静脉破裂和血肿。99 例行手术探查，其中 89 例（46%）患者存在 PF。US 正确诊断 92%的病例，并能明确骨折部位。MRI 主要用于解决问题（13 例），并显示出比 US 更广泛的损伤（12 例）。影像学报告的白膜缺损大小中位数为 7mm（IQR 4-10），明显小于术中探查的结果（中位数 20mm，IQR 10-30；P<0.0001）。
US 在确认 PF 方面具有较高的阳性预测值。MRI 可提高对损伤程度的检测和特征描述。影像学标记可指导手术切口，但所有影像学方法均低估了缺损的大小。
阴茎影像学检查对不仅有助于确认 PF 的诊断，而且有助于评估损伤程度和标记皮肤，从而影响手术技术。骨折以外的其他诊断较为常见，影像学检查可避免不必要的手术探查。
