Treatment of Dorsal Vein Rupture
Dorsal vein rupture of the penis should be managed with immediate surgical exploration and ligation of the severed vessel, as this provides excellent long-term outcomes with complete functional and cosmetic recovery. 1, 2
Clinical Presentation and Diagnosis
Dorsal vein rupture presents similarly to penile fracture but with key distinguishing features:
- Penile swelling and ecchymosis develop following trauma to the erect penis, typically during sexual intercourse 1, 3
- Gradual detumescence occurs rather than the immediate loss of erection seen in true penile fracture 1
- The classic "snap" sound is usually absent (noted in only 2 of 11 cases in one series) 1
- Mild or absent penile pain distinguishes this from penile fracture, which typically causes severe pain 1
- Physical examination reveals no localized tenderness or palpable tunical defect, unlike true penile fracture 1
Diagnostic Approach
Doppler ultrasound of the penis can confirm the diagnosis and exclude rupture of the corpora cavernosa, though surgical exploration remains necessary when reasonable diagnostic doubt exists 2. The clinical presentation alone cannot reliably distinguish dorsal vein rupture from true penile fracture, making exploration essential to avoid missing a tunical tear with potential future complications 1, 3.
Surgical Management
Immediate surgical exploration is the definitive treatment approach:
- Perform exploration under general anesthesia using a circumferential subcoronal incision with degloving of the penile skin 3
- Examine the tunica albuginea of both corpora cavernosa and the penile urethra for injuries 3
- Ligate the severed dorsal vein(s) when identified with intact tunica albuginea 1, 2
- The procedure provides excellent cosmetic and functional results 2
In one series of 17 explorations for suspected penile fracture, 9 revealed only dorsal vein tears with intact tunica albuginea, demonstrating that this condition frequently mimics true penile fracture 3.
Conservative Management Considerations
Conservative management with anti-inflammatory drugs and compressive bandage has been described for cases where the diagnosis is certain and rupture of corpora cavernosa has been definitively excluded 4. However, this approach carries risk of missing a tunical tear. Conservative treatment may be appropriate when:
- Doppler ultrasound definitively excludes tunical injury 2
- Clinical presentation strongly suggests isolated venous injury 4
- The patient can be closely monitored for complications 4
Outcomes and Prognosis
The long-term outcome following surgical ligation is excellent:
- All patients in reported series regained full penile potency without deformity 1
- Complete cosmetic and functional recovery occurs within 2 weeks 2
- Rare complications include transient penile hypoesthesia (1 of 11 cases) 1
- No cases of erectile dysfunction directly attributable to dorsal vein ligation have been reported 1, 3
Critical Pitfall to Avoid
The major pitfall is assuming conservative management is safe without surgical exploration. Although dorsal vein rupture has better prognosis than penile fracture, the clinical presentations are nearly indistinguishable. Missing a concurrent tunical tear can lead to permanent erectile dysfunction, penile curvature, and other serious complications 1, 3. When in doubt, surgical exploration is warranted as it provides both diagnostic certainty and definitive treatment with minimal morbidity 2, 3.