Traumatic Penile Injury

• Compared to most blunt trauma, penile fracture is a rare condition with an incidence rate of 1 in 175,000. 
• It is important that nursing staff be aware of the social inhibitions surrounding penile fracture and the need for early diagnosis and prompt treatment. 
• As healthcare providers, educating young men on the importance of urgency and disclosure for those who present to the emergency department with traumatic groin or penile injuries may stave off long-term complications. 

Injuries from blunt trauma or non-penetrating trauma result from a blunt object meeting the human body with force. Most blunt trauma occurs to the head and abdomen (liver and spleen) because of traumatic injury; motor vehicle collisions, assaults, and falls. Less common is blunt trauma to the male penis, considered a urological emergency.  

The flaccid penis is susceptible to traumatic injury during sexual arousal as the tunica albuginea expands to become thin and vulnerable to fracture.  

Compared to most blunt trauma, penile fracture is a rare condition with an incidence rate of 1 in 175,000. True incident rates may be higher secondary to the social embarrassment, under-reporting and attributed sociocultural characteristics.  

Patients who experience a penile fracture tend to be younger than forty years of age and have a history of erectile dysfunction. In addition, penile fractures may occur under the umbrella of awkward circumstances such as extramarital sex, resulting in a delay or avoidance in seeking medical treatment. 

What Is a Penile Fracture?

A penile fracture is a misnomer because the penis lacks an internal bony framework. A proper definition is a traumatic rupture of the tunica albuginea within one or both corpora cavernosa. The two sponge-like cylinders (corpora cavernosa) make up the penis and fill with blood during arousal, protected by the fibrous envelope of the tunica albuginea.

Within the context of trauma, a fractured penis occurs when the tunica albuginea tears or ruptures from trauma. Most patients with a penile fracture experience a unilateral tear. Compounding injuries can include a rupture of a penile vein, hematoma (bruising) or ligament injury.  

During an erection, blood fills the corpora cavernosa to engorge the penis. When engorged and if bent with sudden force or affected by blunt trauma (thrust against the pubic bone or perineum) the outer lining of the corpora cavernosa (tunica albuginea) ruptures. The fracture most often occurs in the distal two-thirds of the penis. Sexual intercourse, followed by masturbation, are the most common causes and treatment centers on preserving urinary continence and sexual function.  

A rupture of the corpus spongiosum, which supports the urethra, may require prompt surgical intervention to repair and preserve erectile and voiding function. Unlike blunt abdominal trauma, injuries to the genitourinary tract seldom pose a threat to life. But specific to a penis fracture is the associated embarrassment, under-reporting, or hesitancy to disclose or delay seeking medical treatment.

It is important that nursing staff be aware of the social inhibitions surrounding penile fracture and the need for early diagnosis and prompt treatment. Delaying treatment increases the risk of complications, including ischemia, necrosis, and penile deformity.

A Case Study on Penile Fracture

A 39-year-old man presented to your emergency department with an acute onset of groin pain, swelling and the inability to void after experiencing blunt trauma during vigorous sexual intercourse. He was alert and oriented. Triage vital signs: temperature 36.9°C (98.4°F), heart rate seventy-one beats per minute and blood pressure 136/79 mm Hg. 

The patient’s medical and surgical history was unremarkable. He takes no medications, or supplements. Thirty minutes before his ED arrival, he reported hearing a cracking sound followed by the rapid loss of erection. Physical examination showed swelling in the penile shaft, ventral ecchymosis, tenderness, and a dorsal curvature in his penis. Along with a palpable bladder, the urinary meatus had dried blood. The patient’s need to urinate caused increased pain and produced moderate hematuria. The patient declined surgical treatment options but agreed to imaging studies to confirm the diagnosis. For patients who opt for conservative non-surgical management, analgesia antibiotics, ice packs, compression bandages, erection- inhibiting estrogens, penis splints, and fibrinolytic are treatment options. In most cases, conservative management is not ideal and is associated with penile deformities, angulations, and fibrosis, which can lead to erectile dysfunction.  

The patient agreed to a retrograde urethrogram showing urethral disruption. After further consultation, the patient agreed to surgery. Within an hour ED staff transported the patient to the operating room, undergoing immediate surgical exploration and repair of the fracture. For 6-8 weeks post-surgical repair, the physician encouraged the patient to abstain from sexual activities. At the one year follow up, the patient presented with normal erectile and voiding function.  

The Bottom Line

As healthcare providers, educating young men on the importance of urgency and disclosure for those who present to the emergency department with traumatic groin or penile injuries may stave off long-term complications. 

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