|Michael A. Miller, MD||Tripler Army Medical Center, Department of Emergency Medicine, Honolulu, HI|
|Marc E. Levsky, MD||Tripler Army Medical Center, Department of Emergency Medicine, Honolulu, HI|
A 33-year-old male presented to the Emergency Department (ED) with a chief complaint of a painful penis. The patient had been having intercourse with his wife approximately six hours earlier when he felt a bending of his penis, heard an audible “snap,” followed by abrupt pain. The patient was in moderate pain in the ED and was treated with parenteral analgesia. Physical findings were notable for a diffusely tender and ecchymotic penile shaft with deformity (Figures 1). There was no blood at the urethral meatus, and testicular and abdominal examinations were benign.
Penile fracture, or rupture of the tunica albuginea, is caused by trauma to the erect penis most frequently during masturbation (60%) or sexual intercourse (19%).1 It is a relatively uncommon presentation to the ED; almost invariably it presents with the classic history of trauma to the penis, a “snap” and rapid swelling of the penis with erectile detumescence. The diagnosis is generally easy to make with certainty, although thrombosis or rupture of the superficial dorsal vein of the penis can be confused with penile fracture.2 While urethral injury is uncommonly associated with these fractures, it can occur. Treatment is generally surgical although conservative, non-surgical management sometimes is done. Complications include subsequent erectile dysfunction in up to 27% of patients, infection, strictures and deformity.3
Supervising Section Editor: Sean Henderson, MD
Submission history: Submitted June 21, 2009; Revision Received July 15, 2009; Accepted July 22, 2009
Full text available through open access at http://escholarship.org/uc/uciem_westjem
Address for Correspondence: Michael A. Miller MD, Department of Emergency Medicine, Tripler Army Medical Center, Honolulu, Hawaii 96859
Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources, and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.
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