From the Guidelines
When evaluating a patient for a suspected penile fracture, notable features on an MRI include a rupture of the tunica albuginea, hematoma, and potential urethral injury, which can help confirm the diagnosis and guide surgical intervention. The diagnosis of penile fracture is typically made based on clinical history and physical examination, with symptoms such as penile ecchymosis, swelling, cracking or snapping sound during intercourse or manipulation, and immediate detumescence 1. However, in cases with equivocal signs and symptoms, imaging studies like ultrasound or MRI can be used to assist with confirmation or exclusion of the diagnosis 1.
Some key points to consider when evaluating a patient for penile fracture include:
- Clinical history of forceful bending of the erect penis, an audible “pop” or “snap,” rapid detumescence, and penile ecchymosis 1
- Physical examination findings of penile swelling, ecchymosis, and potential deformity 1
- Use of imaging studies like ultrasound or MRI to confirm the diagnosis in equivocal cases 1
- Potential for concurrent urethral injury, which should be evaluated with retrograde urethrography if suspected 1
It's essential to note that prompt surgical exploration and repair is the recommended approach for suspected penile fracture, as it is associated with lower risk of erectile dysfunction and penile curvature 1. The most recent and highest quality study, published in 2021, supports the use of ultrasound and MRI in patients with equivocal signs and symptoms of penile fracture 1.
In terms of management, surgery involves degloving the penis, evacuating the hematoma, identifying the tear in the tunica albuginea, and repairing it with absorbable sutures, with concurrent urethral injury evaluated and repaired if necessary 1. Postoperative care includes antibiotics, pain management, and abstinence from sexual activity for 6-8 weeks 1.
From the Research
Notable Features in an MRI for Ruling Out Penile Fracture
- Discontinuity of the tunica albuginea, which manifests as a tear in the low-signal-intensity structure on both T1- and T2-weighted images 2, 3, 4
- Presence of intracavernosal or extratunical hematoma, which can be demonstrated on T1-weighted and T2-weighted images 2, 3, 4
- Associated injuries to adjacent structures, such as the corpus spongiosum or urethra, which can be visualized on MRI 2, 3
- Intact tunica albuginea in patients with no penile fracture, which can be confirmed on MRI 2
Diagnostic Approach
- MRI is a useful diagnostic tool in the evaluation of patients with suspected penile fracture, with a sensitivity of 91.9% and specificity of 90.6% 5
- Ultrasound (US) can also be used to rule out penile fracture, with a sensitivity of 71.4% and specificity of 100.0% 5
- Clinical examination and history are also important in diagnosing penile fracture, with signs such as a detumescent penis, diffuse penile swelling, and ecchymosis (the "eggplant sign") 6
Management Approach
- Immediate surgical management is the mainstay of treatment for penile fracture, with many surgeons favouring a degloving approach 6
- MRI can help plan appropriate surgical management by confirming the fracture site and visualizing associated injuries 2, 3, 4
- Follow-up MRI can also be used to monitor the healing process after surgical repair 3, 4