ABSTRACT
Rupture of the tunica mostly occurs on the ventral aspect of the penis, particularly if a coital injury is the cause. 3 This can be explained both by the mechanism of injury (direction of the arm of force) and by the sturdy nature of the dorsal aspect of the penis in comparison with the ventral aspect. The tunica albuginea is thicker dorsally than ventrally, and is less liable to stretch beyond its limit in the erect state, thus preventing the erect penis from bending ventrally. It is therefore less liable to rupture. The dorsal aspect is further supported by the neurovascular bundle. In case of overwhelmingly forceful ventral bending, the dorsal vessels are more liable to snap than is the dorsal tunica albuginea, and the resulting pain usually brings the traumatic force to a stop, protecting the dorsal tunica from further development of pressure. Accordingly, ventral bending of the erect penis is less likely than dorsal bending, and thus ventral rupture is more likely than dorsal rupture. Nevertheless, though it is rare, dorsal rupture of the tunica albuginea does occur. 5
Injury of the urethra is widely reported as a complication of penile fracture, occurring in up to 38 % in one case series, 8 and ranging from partial injury to complete disruption. 3 A clear variation in the incidence of urethral injuries has been noticed in correlation with the modality of trauma, being higher in coital injuries. This was explained by the higher magnitude of force with coital trauma in comparison with manipulation injuries. 5
If surgical repair is not undertaken, the defect usually heals by secondary intention, and the hematoma becomes organized and encapsulated. The healed tear in the tunica albuginea is relatively weak and is therefore liable to aneurysmal dilatation and may be the site of venous leakage, resulting in erectile dysfunction (ED). 10 The neglected hematoma may lead to abscess formation or deformity. 11
Although fracture of the penis implies rupture of the corpus cavernosum, the resultant hematoma may be exacerbated further by associated injuries, such as rupture of the superficial vessels of the penis or tears in Dartos muscle or in Buck ’ s fascia, which is firmly adherent to the tunica albuginea. 12
Penile fracture is the result of blunt trauma or bending force applied to the erect penis. The causative incident is almost
of the hematoma declines, probably owing to detumescence and pain-induced vasoconstriction, both of which arrest the bleeding.21 Distribution of the hematoma depends in part on the integrity of fascial layers of the penis. If Buck ’ s fascia is intact, ecchymosis is confined within Buck’s fascia over the tear, and the patient has a well-defined collection and the so-called eggplant deformity. 22 When Buck ’ s fascia is compromised, the collection seeps to Colles ’ fascia, in which case extravasation is diffuse and assumes a ‘butterfly’ pattern over the perineum, scrotum, and lower anterior abdominal wall.23 In cases of early presentation, this distribution may be masked by edema. 21 It should be noted that the hematoma does not necessarily coincide with the defect. If Buck ’ s fascia is torn, blood may proceed to Colle ’ s fascia and assume a wide, nonspecific distribution. 21 Patients may have angulation of the penis, commonly away from the site of rupture. Deviation in this early stage is caused by hematoma and edema.24
