What is the treatment for penile swelling and bruising?

Treatment of Penile Swelling and Bruising

The treatment approach depends critically on the underlying cause: if penile fracture is suspected (history of trauma with snapping sound, immediate detumescence, ecchymosis, and swelling), immediate surgical exploration and repair is mandatory; otherwise, conservative management with observation, NSAIDs, and avoidance of sexual activity is appropriate.

Initial Diagnostic Approach

Suspect Penile Fracture When:

• Patient reports penile ecchymosis, swelling, cracking or snapping sound during intercourse or manipulation, and immediate detumescence 1
• Physical examination reveals swollen, ecchymotic, and potentially deviated penis 2
• Most patients describe a cracking or snapping sound followed by immediate detumescence, along with penile pain and possible penile angulation 1

Evaluate for Concomitant Urethral Injury:

• Must perform evaluation for urethral injury if blood at urethral meatus, gross hematuria, or inability to void is present 1
• Options include urethroscopy or retrograde urethrogram; neither method is superior 1
• Bilateral corporal body fracture is an additional risk factor for urethral injury 1

Treatment Algorithm

For Confirmed or Suspected Penile Fracture:

Surgeons should perform prompt surgical exploration and repair 1. This is a Standard recommendation with Grade B evidence strength.

• Repair is performed by exposing the injured corpus cavernosum through either a ventral midline or circumcision incision 1
• Tunical repair is performed with absorbable suture and should be performed at the time of presentation to improve long-term patient outcomes 1
• A degloving procedure provides the best exposure for blunt and penetrating trauma 3
• Saline injection can show additional corporeal body and/or urethral pathology and assess the integrity of repair 3

For Equivocal Cases:

• May perform ultrasound in patients with equivocal signs and symptoms 1
• MRI can be considered when ultrasound is equivocal 1
• If imaging is equivocal or diagnosis remains in doubt, surgical exploration should be performed 1

For Non-Traumatic Penile Swelling and Bruising:

Consider Alternative Diagnoses:

• Penis friction edema: Results from traumatic disorder of lymph drainage, manifests as local or total penile edema or cordlike congestion of lymphatic vessels 4
• Isolated rupture of deep dorsal vein: Has essentially the same presentation as corpus cavernosal rupture with sudden onset of pain, swelling, and ecchymosis during sexual intercourse 5

Conservative Management:

• Temporary abstinence from sexual intercourse is the primary treatment for friction edema 4
• Diagnosis is by exclusion after infectious and obstructive causes have been eliminated 4
• The swelling typically disappears during several weeks of abstinence 4

For Treatment-Related Penile Swelling:

Minor Penile Swelling from Intralesional Interferon α-2b:

• Can be effectively treated with over-the-counter nonsteroidal anti-inflammatory medications 1
• Symptoms typically last less than 48 hours 1
• Oral hydration is helpful to mitigate these transient symptoms 1

Penile Bruising from Intralesional Verapamil:

• Penile bruising is a known potential adverse event along with dizziness, nausea, and pain at the injection site 1
• Patients should be counseled about these potential adverse events prior to beginning treatment 1

Critical Pitfalls to Avoid

• Do not delay surgical intervention for suspected penile fracture: Prompt surgical repair at the time of presentation improves long-term patient outcomes 1
• Do not miss concomitant urethral injury: Always evaluate for urethral injury when blood at meatus, gross hematuria, or inability to void is present 1
• Do not assume all penile swelling and bruising is fracture: Consider alternative diagnoses like friction edema or isolated dorsal vein rupture, which may be managed conservatively 4, 5
• Patients may delay admission due to fear and embarrassment: Maintain high clinical suspicion even with incomplete history 2

Expected Outcomes with Appropriate Management

• At follow-up after surgical repair of penile fracture, 35 of 40 patients (87.5%) reported erection adequate for intercourse without erectile or voiding dysfunction 3
• Only 2 patients had mild curvature as a complication 3
• Conservative management of friction edema results in complete resolution with abstinence 4