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I have completed bits of my EM training from India. Currently I am boarded with credentials from Christian Medical College, Vellore and also from the prestigious Royal College of Emergency Medicine, UK.  I am currently working in London as an A&E doctor, trying to appreciate the differences in the practise and culture of Emergency Medicine across different healthcare systems. I have always been an avid FOAMed supporter because FOAMed played an indispensable role during the days of my initial training. Through this blog, I aspire to disseminate knowledge and stay up to date with the EM literature. 

Tuesday, February 10, 2015

Penile Fracture : Is it possible?

Yes, Penile trauma can lead to PENILE FRACTURE. This is a rare injury, but as Emergency Physicians we need to know about this (presentation/Investigations and Rx) to liaise with the Urologists. Lets see how it presents and what we need to look for:

Fracture of the penis is a surgical emergency that results from blunt trauma to the erect penis.
When flaccid, the penis can withstand a certain amount of stress due to the thick tunica albuginea. However, when the penis is erect, the tunica albuginea stretches over the engorged corpora cavernosa, making it vulnerable to rupture when placed under significant strain. Unfortunately, medical care is often delayed, due to the embarrassing nature of the condition.



The majority of penile fractures result from vigorous vaginal intercourse, can also occur following manipulation of the penis during masturbation, and rarely, following trauma.

Classical history - i.e. vigorous sexual intercouse which is interrupted by sudden pain in the penis, often in association with a popping sound; this is followed by immediate detumescence, and swelling and bruising of the penis. Urinary symptoms such as dysuria, poor stream, urinary retention and meatal bleeding, may be seen if the injury involves the penile urethra.

On examination, an ‘egg-plant deformity’ of the penis is typically seen due to the combination of swelling of the penis, and bruising and deviation to the side opposite to the tear. The bruising is often contained within Buck’s fascia and therefore appears localised to the penile shaft. If the fascia has also been damaged, blood may track down into the scrotum, supra pubic area or the perineum.

On palpation, a hematoma may be located over the site of the tear, or the tear may be palpable as a defect; the 'rolling sign' (where the penile skin can be rolled above a firm immobile hematoma on the shaft) may also be present.

The diagnosis of penile fracture is mainly clinical. Investigations are warranted only if the clinical features are equivocal, if signs and symptoms suggestive of urethral injury are present, or if the patient presents late. Bilateral tears also warrant investigations, as the chance of urethral injury is much higher in these patients.

In such individuals, retrograde urethrography, cavernosography, ultrasonography and magnetic resonance imaging (MRI) may prove to be of use.

Retrograde urethrography is quick and inexpensive, and can easily identify urethral tears; however, current evidence does not support its routine use in all patients with penile fracture.

The technique of penile cavernosography involves injection of contrast medium into the corpora cavernosa by direct injection. A series of fluoroscopic images is subsequently obtained, with the presence of contrast leakage across the tunica albuginea being confirmatory of the condition; this will also help localize the exact location of the tear. Note that the procedure is not without complications; priapism, allergic reactions and fibrosis of the corpus cavernosa have been observed.

Ultrasound imaging is less informative but may prove advantageous in pediatric patients; while MRI has the ability to visualize the anatomy clearly, the time and cost may be an issue.

From the ED Management perspective, we need to give them adequate analgesia (Meds, Cold Compression) and get Urology ASAP. Most authorities agree that urgent surgical exploration and repair is the first-line treatment in these patients. Overall, surgical repair has an excellent outcome.

Complications: permanent penile deviation due to fibrosis, fistulae formation between the urethra and skin or the corpora cavernosa, urethral strictures, painful erections, and erectile dysfunction.

Conservative measures such as ice packs, foley catheterization and anti-inflammatory agents have been used in the past, success rates were low, and complication rates high. Now, these are only used as an adjunct to surgery.


Take home:
1. Penile fracture is a clinical diagnosis (Investigate only if C/F equivocal, suspected uretheral injury, delayed presentation)
2. The presence of associated urinary symptoms should raise strong suspicion of urethral injury.
3. Urgent surgical exploration and repair is the cornerstone of management.

References
1. EKE N.. Fracture of the penis. Br J Surg [online] 2002 May, 89(5):555-565 [viewed 20 June 2014] Available from: doi:10.1046/j.1365-2168.2002.02075.x
2. JACK GS, GARRAWAY I, REZNICHEK R, RAJFER J. Current Treatment Options for Penile Fractures Rev Urol [online] 2004, 6(3):114-120 [viewed 20 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472832
3. MURRAY KATIE S., GILBERT MICHAEL, RICCI LAWRENCE R., KHARE NARENDRA, BROGHAMMER JOSHUA. Penile fracture and magnetic resonance imaging. Int. braz j urol. [online] 2012 April, 38(2):287-288 [viewed 20 June 2014] Available from: doi:10.1590/S1677-55382012000200019

4. Amer, Tarik, et al. "Penile Fracture: A Meta-Analysis." Urologia internationalis96.3 (2016): 315-329.


12 comments:

  1. Replies
    1. PENIS ENLARGEMENT SPELL- greatherbshealingcentre@gmail.com
      FOR YOUR PENIS TO BE GREAT FOR LOVE MAKING.

      Try our VERY POWERFUL PENIS/MUSCLE/TESTICLES MAGIC AND HEIGHT SPELL which will make your penis BIG AND EFFECTIVE . .You must be 18 yrs of age and above to order for this Magical spell/ item to enlarge your penis ,make it powerful ,strong and thick.
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      RESULTS AFTER CASTING OUR PENIS ENLARGEMENT SPELL;
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      -Have multiple orgasms
      -Ends Early ejaculation
      -Increased stamina

      A. testimony released from Mat.United State on the 18th November 2016.

      Dear Powerful Spell Caster,

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      You are the best in PENIS ENLARGEMENT works. There is no system and pills of enlargement and enhancement I have not bought and used. You have saved my marriage from breaking.

      I make love now like never before, my Penis has grown up to 12 inches, ejaculation is delayed, I ejaculate several times and I don't know where the strength to make love over and over is coming.

      YOUR PENIS ENLARGEMENT SPELL is something else. I don't know how to describe it. It is so powerful. Three friends will be making their orders in December and early next year, please make it powerful just like mine so that they will not be disappointed.

      I will tell all my other friends about your best penis enlargement spell.

      Thank you so much.

      I am permitting you to use this letter on your testimonial page with my name .

      You must not display my email address AND phone number on any of your pages.

      FOR ORDERS
      CALL- Dr Onienie +1(256)344-1029 my phone number if you have any question to ask and also I am on IMO chat you can add me up there with same phone number
      EMAIL- greatherbshealingcentre@gmail.com

      Delete
    2. hello everyone here.i am so much in joy to share this glorious and marvellous testimony of DR SALATO herbal cream and liquid that saved my marriage from shame and divorce.
      My name is Alberto Modric from spain and i am a married man but was not happy with my life and marriage because of my penis size was embarrassing and frustrating,imagine a man of 37 years old having 2.4 inches penis when fully erected,to worsen it all ,i cannot even last 1 minute in bed and it was really destroying my marriage because my wife was always complaining anytime we make love and she said that i cannot satisfy her the way a man is suppose to satisfy his wife in bed also she was about to seek divorce because of my weakness in bed .i was frustrated and devastated because i have used so many product both online and hospital and non was able to enlarge my penis but when i was searching through the internet for a herbal cure and penis enlargement then i saw a testimony of so many people testifying about DR SALATO HERBAL PENIS ENLARGEMENT CREAM AND LIQUID on how DR SALATO help them to enlarge their penis size then i decided to try my luck by contacting him through his website https://drsalatosolutionte0.wixsite.com/drsalato and he replied me also gave me some encouraging words and told me what to do which i did and to my greatest surprise after one week of using his herbal cream and liquid that he sent to me through UPS delivery service my penis size grow to 7 inches when fully erected and now it is two weeks of treatment and my penis size is 11 inches and my wife is always screaming anytime i make love to her,saying that i am killing her with my big dick and i can stay in bed for more than 3 hours without cumming.
      i am so happy that DR SALATO save my marriage for me and i am thankful to him also i promise to spread his good work around the globe and my friends if you are experiencing such problem in your marriage or you are sick then do not hesitate to contact him on his email
      drsalatosolutiontemple@gmail.com or visit his
      website https://drsalatosolutionte0.wixsite.com/drsalato
      you can call/whatsapp him +2348103629945.
      THANKS FOR READING MY TESTIMONY

      Delete
  2. Erectile dysfunction is a serious, troubling problem but you don’t have to just suffer silently. Numerous treatment options exist and many of these can deliver excellent results.

    Before looking for a treatment, it’s very important to have your health thoroughly checked. ED could be the symptom of another medical issue. Having another medical problem ruled out will then make it easier to overcome ED and enjoy a much more satisfying sex life.

    ReplyDelete
    Replies
    1. PENIS ENLARGEMENT SPELL- greatherbshealingcentre@gmail.com
      FOR YOUR PENIS TO BE GREAT FOR LOVE MAKING.

      Try our VERY POWERFUL PENIS/MUSCLE/TESTICLES MAGIC AND HEIGHT SPELL which will make your penis BIG AND EFFECTIVE . .You must be 18 yrs of age and above to order for this Magical spell/ item to enlarge your penis ,make it powerful ,strong and thick.
      OUR SPECIAL PENIS/MUSCLE/TESTICLES MAGIC AND HEIGHT SPELL WILL BE CAST TO YOU ACCORDING TO YOUR ORDER AND YOU WILL START TO SEE GREAT RESULT IMMEDIATELY

      RESULTS AFTER CASTING OUR PENIS ENLARGEMENT SPELL;
      -Permanent penis enlargement
      -Thick penis
      -Bigger penis head
      -Improved force and intensity
      -Boosted semen quantity
      - Effective erections
      -Cures and prevents impotence
      -Have multiple orgasms
      -Ends Early ejaculation
      -Increased stamina

      A. testimony released from Mat.United State on the 18th November 2016.

      Dear Powerful Spell Caster,

      I did every thing as you instructed me and i am so happy to let you know i got my desired length. Your Spell is very quick and your instructions are so simple to follow and I have not noticed any negative side effect at all.

      You are the best in PENIS ENLARGEMENT works. There is no system and pills of enlargement and enhancement I have not bought and used. You have saved my marriage from breaking.

      I make love now like never before, my Penis has grown up to 12 inches, ejaculation is delayed, I ejaculate several times and I don't know where the strength to make love over and over is coming.

      YOUR PENIS ENLARGEMENT SPELL is something else. I don't know how to describe it. It is so powerful. Three friends will be making their orders in December and early next year, please make it powerful just like mine so that they will not be disappointed.

      I will tell all my other friends about your best penis enlargement spell.

      Thank you so much.

      I am permitting you to use this letter on your testimonial page with my name .

      You must not display my email address AND phone number on any of your pages.

      FOR ORDERS
      CALL- Dr Onienie +1(256)344-1029 my phone number if you have any question to ask and also I am on IMO chat you can add me up there with same phone number
      EMAIL- greatherbshealingcentre@gmail.com

      Delete
  3. Hello everyone i Am Zack and i am from SA i am here to give my testimony about an herbal doctor called Dr,DADA I was heartbroken because i had very small penis,not nice to satisfy a woman, i have been in so many relationship, but cut off because of my situation, i have used so many product which doctors prescribe for me, but could not offer me the help i searched for. i saw some few comments on the internet about this specialist called Dr,DADA and decided to email him on his email i saw on the internet,(drdadaspellhome@gmail.com ) so I decided to give his herbal product a try. i emailed him and he got back to me, he gave me some comforting words with his herbal product for Penis Enlargement, Within three weeks of me use it, i began to feel the enlargement, " and now it just 4 weeks of using his products my penis is about 8 inches longer, and i had to settle thing out with my ex girlfriend , i was surprised when she said that she is satisfied with my performance in bed and i now have a large penis.thanks to Dr,DADA for is herbal product. you can also reach him with this whatsApp number +2348158568638

    ReplyDelete
  4. I am alive today because Dr.Ogudugu helped me to recover from the pains that i was going through, My name is Elliott from Chicago and i am very happy to express my appreciation to Dr.Ogudugu for helping me to get my husband back to me. I was finally able to contact Dr.Ogudugu who helped me to get my husband, I am glad to drop Dr.Ogudugu details which are: greatogudugu@gmail.com or WhatsApp No: +2348139793075 for urgent help to get your life partner back

    ReplyDelete
  5. PENIS ENLARGEMENT SPELL- greatherbshealingcentre@gmail.com
    FOR YOUR PENIS TO BE GREAT FOR LOVE MAKING.

    Try our VERY POWERFUL PENIS/MUSCLE/TESTICLES MAGIC AND HEIGHT SPELL which will make your penis BIG AND EFFECTIVE . .You must be 18 yrs of age and above to order for this Magical spell/ item to enlarge your penis ,make it powerful ,strong and thick.
    OUR SPECIAL PENIS/MUSCLE/TESTICLES MAGIC AND HEIGHT SPELL WILL BE CAST TO YOU ACCORDING TO YOUR ORDER AND YOU WILL START TO SEE GREAT RESULT IMMEDIATELY

    RESULTS AFTER CASTING OUR PENIS ENLARGEMENT SPELL;
    -Permanent penis enlargement
    -Thick penis
    -Bigger penis head
    -Improved force and intensity
    -Boosted semen quantity
    - Effective erections
    -Cures and prevents impotence
    -Have multiple orgasms
    -Ends Early ejaculation
    -Increased stamina

    A. testimony released from Mat.United State on the 18th November 2016.

    Dear Powerful Spell Caster,

    I did every thing as you instructed me and i am so happy to let you know i got my desired length. Your Spell is very quick and your instructions are so simple to follow and I have not noticed any negative side effect at all.

    You are the best in PENIS ENLARGEMENT works. There is no system and pills of enlargement and enhancement I have not bought and used. You have saved my marriage from breaking.

    I make love now like never before, my Penis has grown up to 12 inches, ejaculation is delayed, I ejaculate several times and I don't know where the strength to make love over and over is coming.

    YOUR PENIS ENLARGEMENT SPELL is something else. I don't know how to describe it. It is so powerful. Three friends will be making their orders in December and early next year, please make it powerful just like mine so that they will not be disappointed.

    I will tell all my other friends about your best penis enlargement spell.

    Thank you so much.

    I am permitting you to use this letter on your testimonial page with my name .

    You must not display my email address AND phone number on any of your pages.

    FOR ORDERS
    CALL- Dr Onienie +1(256)344-1029 my phone number if you have any question to ask and also I am on IMO chat you can add me up there with same phone number
    EMAIL- greatherbshealingcentre@gmail.com

    ReplyDelete
  6. hello everyone here.i am so much in joy to share this glorious and marvellous testimony of DR SALATO herbal cream and liquid that saved my marriage from shame and divorce.
    My name is Alberto Modric from spain and i am a married man but was not happy with my life and marriage because of my penis size was embarrassing and frustrating,imagine a man of 37 years old having 2.4 inches penis when fully erected,to worsen it all ,i cannot even last 1 minute in bed and it was really destroying my marriage because my wife was always complaining anytime we make love and she said that i cannot satisfy her the way a man is suppose to satisfy his wife in bed also she was about to seek divorce because of my weakness in bed .i was frustrated and devastated because i have used so many product both online and hospital and non was able to enlarge my penis but when i was searching through the internet for a herbal cure and penis enlargement then i saw a testimony of so many people testifying about DR SALATO HERBAL PENIS ENLARGEMENT CREAM AND LIQUID on how DR SALATO help them to enlarge their penis size then i decided to try my luck by contacting him through his website https://drsalatosolutionte0.wixsite.com/drsalato and he replied me also gave me some encouraging words and told me what to do which i did and to my greatest surprise after one week of using his herbal cream and liquid that he sent to me through UPS delivery service my penis size grow to 7 inches when fully erected and now it is two weeks of treatment and my penis size is 11 inches and my wife is always screaming anytime i make love to her,saying that i am killing her with my big dick and i can stay in bed for more than 3 hours without cumming.
    i am so happy that DR SALATO save my marriage for me and i am thankful to him also i promise to spread his good work around the globe and my friends if you are experiencing such problem in your marriage or you are sick then do not hesitate to contact him on his email
    drsalatosolutiontemple@gmail.com or visit his
    website https://drsalatosolutionte0.wixsite.com/drsalato
    you can call/whatsapp him +2348103629945.
    THANKS FOR READING MY TESTIMONY

    ReplyDelete
  7. hello everyone here, my name is Adam Willson am from United Kingdom , i want to share a great testimony of how Dr CHO-CHA herbal mixture product saves me from shame and disgrace, my penis size was a big problem to me as the size was really so embarrassing and discouraging, a 39 year old full grown man like me having 4 inches penis and to worsen it i don't last in sex i cant even last two minutes it was really a thing of shame my wife was really tired of me because my sex life was very poor , she never enjoyed sex, i was always thinking and searching for solutions everywhere until last two months when i saw a testimony of how Dr CHO-CHA herbal mixture have been helping people from the globe,i saw one MR GARRY PHIIPS testifying of how Dr CHO-CHA helped him enlarge his penis size so i decided to give him a try ,we talked and gave me steps to follow which i did and to my greatest surprise in less than two weeks of taking the herbal mixture my penis grow to 8 inches i couldn't believe my eyes and as i speak now my penis is now 10 inches long and i was amazed when my wife said i satisfy her so well now all thanks to Dr CHO-CHA herbal mixture,i will forever be grateful yo him

    i also learnt that Dr CHO-CHA also have the herbal cure to problems like

    DIABETE 1/2

    HERPES GENITAL

    CANCER

    HIV/AIDS

    ALS

    HPV 123

    PILE

    ASTHMA

    HEART FAILURE

    STROKE

    HEPATITIS A,B,C

    so if you you are suffering from any of this problems please do not hesitate to contact him now email via

    ( chochaherbalarenaforhealing@gmail.com

    (chochaherbalarenaforhealing@yahoo.com)

    or Whatsapp Dr CHO-CHA via whatsapp +2348158568638

    ReplyDelete
  8. I would like to let all know that the size of your Penis really matters in
    your relationship or marriage. I got married to my wife about 1 month after
    we met on a photo studio, we lived happily for the first 3 months of our
    marriage until i and my wife start having quarrels at home because i
    couldn’t satisfy her on bed with my little penis. Actually my penis was
    very small, it measured about 4.5 inch long on erection and i am 33 years
    old. My wife said it was forbidden by the women of this world. My wife
    started sleeping with other men outside. Sometimes i will return from work
    without finding my wife at home and whenever i call or ask her where she
    was, she will always snub at me and sometimes just tell me to go get a
    larger dick. All this continued for a long time and it hurt me so much that
    i was at the edge of breaking up on the marriage till when i read about a
    doctor called DR. AKIOYA online. I never thought i could smile and be in a
    happy marriage again if not for the help of DR.AKIOYA I got the doctors
    Emails: drakioya17spellhome@gmail.com. on the internet and i emailed him, and
    he got back to me with some encouraging words, he got me some herbs which i
    use for just 8 days and i began to feel the enlargement of my penis, and
    without surgery. This went on for a little period of about 10 days and to
    my surprise my wife keeps screaming that she love my big dick now. Now my
    wife no longer cheat on me, and my penis is now about 10.5 inches long on
    erection and off course very large round. And now my wife uses breasts,
    hips and bums enlargement. I and my wife are very happy for the help
    rendered to me by DR.AKIOYA, and i want to say a big thanks to Doctor for the
    help. You can contact the Doctor now on his Email: drakioya17spellhomegmail.com Am
    thankful to the doctor for helping me. you can call him whatsapp +2348105257464

    ReplyDelete
  9. I'm Here to tell people over the world how Dr.john is real herbalist that we help you in any situation problem...my testimony is about a herbalist Doctor called Dr.john I was heartbroken because i had a very SMALL PENIS, not big enough to satisfy a Woman, i have been in so many relationship,but cut off because of my situation, i have used so many product which doctors prescribe for me, but none could offer me the help i searched for. i saw some few comments on the internet about this specialist called Dr.john and decided to email him on his email i saw on the internet, (rjohneDnlargementhome@gmail.com) so I decided to give his herbal medicine a try. i emailed him and he got back to me, he gave me some comforting words with his herbal medicine for Penis Enlargement,Within 2 week of it, i began to feel the Enlargement of my penis, "and now it just 3 weeks of using his herbal medicine my Penis is about 10 inches longer, and i had to settle out with my Ex (Girlfriend) i was surprised when she said that she is satisfied with my sex and i have got a large penis,Am so happy..email him to help you too.his WhatsApp number:+2348060259313
    he also specialize on the following things

    Permanent penis enlargement
    Thick penis
    Bigger penis head
    Improved force and intensity
    Boosted semen quantity
    Effective erections
    Cures and prevents impotence
    Have multiple orgasms
    Ends Early ejaculationb
    Increased stamina
    Hight blood presure
    Best regard
    JOHN AUSTIN

    ReplyDelete