Treatment of Penis Fractures With Urethral Rupture

A penile fracture is an emergency that requires surgery on the day a patient is admitted to the hospital. The treatment of a fracture of a penis with a rupture of the urethra is complex, and success depends on where you get medical care. It is best to go to a reputable hospital not only to eliminate all the consequences of the injury but also to preserve the aesthetics of the penis and erectile function and avoid problems with urination. You can get medical care abroad. You are welcome to use the Booking Health service to find out the cost of treatment and compare prices at different hospitals.

Content

1. Causes of the injury
2. Diagnostics
3. Principles of the treatment of a fracture of a penis with a rupture of the urethra
4. How do doctors perform surgery for penile fracture?
5. Urethral reconstructive surgery
6. Where to undergo your treatment of a fracture of a penis with a rupture of the urethra?

Causes of the injury

Penile injuries are uncommon. In 80% of cases, they are closed, and in another 20% of cases, these injuries are open. The most common blunt injury to the penis is a fracture. It can occur only when the trauma is inflicted during erection. The injury is manifested by a tear in the tunica albuginea and cavernous bodies. In 20% of cases, fractures of the penis are combined with subcutaneous hematomas, cavernous body injuries, and urethral injuries. According to different authors, from 6 to 9% of fractures of the penis are combined with a urethral rupture.

If a man is injured at a time when his dick is in a non-erect state, a tear in the albuginea sheaths will not occur. The consequences of such an injury usually cause only a hematoma.

The cause of a fracture of the penis is its strong and sharp bending during sexual intercourse, masturbation, falling out of bed, or changing body position. Cases of the fracture are described when deliberately bending the penis to relax it. The cause of 60% of all injuries is sexual intercourse with a woman on top.

Diagnostics

Patients report sharp pain that is felt at the time of an injury. Many men note that they hear a cracking sound. Their erection disappears, which is followed by the development of edema and hematoma ("bruise").

A sign of urethral trauma is the presence of blood in its outer opening. At the same time, urinary retention does not necessarily indicate a urethral rupture. It can also be associated with compression of the urethra by a hematoma, which is an accumulation of blood in the surrounding soft tissues.

The diagnosis is established by clinical methods. In doubtful cases, an ultrasound scan can be used to confirm it as well as assess the nature of the trauma. An MRI scan is not commonly used.

Principles of the treatment of a fracture of a penis with a rupture of the urethra

A patient should receive his treatment as soon as possible. After admission to the urology department, a man is examined, and a surgical intervention is immediately performed. The best aesthetic and functional results can be achieved when the operation is performed on the first day after the injury. As the injury "ages", the results worsen, as it becomes more difficult to cope with all the consequences.

The treatment of a fracture of a penis with a rupture of the urethra aims to:

• restore the integrity of the organ; 
• seal cavernous bodies; 
• achieve a good aesthetic result; 
• maintain erectile function; 
• restore the integrity of the urethra by suturing defects, applying an anastomosis, or reconstructing it.

Urethral ruptures are classified as complete or partial. Partial ruptures denote the tearing of a portion of the wall rather than the entire wall. The treatment of a fracture of a penis with a rupture of the urethra may involve surgery on the penile tissue only, while the urethra will be repaired without any suturing. It is enough to implant a silicone catheter for 10 days. This approach is used if the rupture area does not penetrate all layers, has a length of no more than 2.5 cm, and the transverse rupture area does not exceed one-third of the radius of the urethra.

Many patients require rehabilitation after the treatment of a fracture of a penis with a rupture of the urethra. There are two major problems: erection disorders and fear of sexual intercourse if it has caused the injury. Some men have urination problems because scar tissue may grow in the urethra.

How do doctors perform surgery for penile fracture?

The treatment of a fracture of a penis with a rupture of the urethra is provided on an emergency basis, immediately after the diagnosis is established. Do not hesitate to contact the specialists at Booking Health if you want to travel abroad. We will select a hospital for your urgent treatment abroad and help you quickly collect the necessary documents. We will also book hotel and airline tickets and take care of any other organizational issues.

Below are listed the principles of the treatment of a fracture of a penis with a rupture of the urethra:

1. hematoma evacuation;
2. determination of the area of damage to the albuginea sheaths of the cavernous bodies and their suturing;
3. restoration of the urethral integrity. 

The technique of the surgical treatment of a fracture of a penis with a rupture of the urethra can vary greatly at different hospitals. Some doctors make an incision directly over the injured area. In this case, the treatment is less traumatic.

If the urethra is injured, surgeons make a circular subcoronary incision, stepping back 1 cm from the coronal sulcus of the genital organ. It allows access to the cavernous body and urethra, opposite the ruptured site. The disadvantage of a circular incision is a decreased sensitivity of the organ after the treatment of a fracture of a penis with a rupture of the urethra. Other problems may include lesions to the vascular bundle and skin necrosis.

Another option is an inguinoscrotal approach, which allows for a comprehensive revision of the dick tissues.

Whatever the incision, during the operation, a doctor excises the soft tissues, opens the Buck's fascia, and removes the accumulated blood to eliminate the hematoma. The nature of the rupture of the tunica albuginea is assessed. It usually goes sideways. If it is difficult to detect the ruptured area, the doctor injects a dye (methylene blue) into the cavernous body. The site from which it flows is a fractured zone.

The defect of the tunica albuginea is sutured. It is important that the sutures are tight. After suturing, their tightness is checked by injecting saline into the cavernous body. This injection mimics an erection. With the help of this manipulation, doctors can both detect additional ruptured areas and identify poorly sutured areas.

As a result of the injury, the skin of the dick can sometimes be severely damaged. This does not affect the function of the genital organ but creates an aesthetic defect. In this case, the treatment of a fracture of a penis with a rupture of the urethra can be supplemented by skin plastic surgery. Doctors transplant flaps from other parts of the body. This manipulation can be performed both simultaneously and at the second stage of surgical treatment.

Urethral reconstructive surgery

An important step in the treatment of a fracture of a penis with a rupture of the urethra is the repair of the integrity of the urethra. Urethral ruptures can be longitudinal and transverse, complete (through all layers of the wall), or partial. Sometimes the injury may be so severe that a patient develops urethral defects (lack of tissue). This fact forces doctors to resort to reconstructive surgery, although this is rare.

All patients with concomitant urethral injuries, without exception, are implanted with a urethral drainage. Surgical options for the repair of the integrity of the urethra are the following:

• a primary urethral suture implies that the ruptured area is immediately sutured; 
• a Foley catheter placement procedure may be a sufficient measure for a partial rupture, in which the canal self-heals;
• a urethral anastomosis consists of suturing the ends of the urethra, if a patient has a complete transverse tear;
• urethral reconstruction with autologous tissues. 

Urethral surgery is a complex field of medicine, so it is best to undergo your treatment of a fracture of a penis with a rupture of the urethra at a specialized hospital abroad to expect good functional outcomes. Operations are associated with many difficulties, such as a complex anatomical area, the impossibility of manipulating a conventional surgical instrument, a narrow operating field, and poor visibility. If you are undergoing your treatment of a fracture of a penis with a rupture of the urethra abroad, your health will be in the safe hands of experienced doctors from specialized centers who have performed hundreds of operations on the penis and urethra. The specialists can perform the most complex interventions, including those that require a partial removal of the urethra, an anastomosis, or urethral reconstruction from other tissues.

When a patient has a fracture of the genital organ, the urethra is usually not very affected. But in some cases, the urethra is so damaged that it is subject to a partial removal. In this case, doctors can repair the urethra with reconstructive surgery. They use tissue from other parts of the body to form part of the urethra and create an anastomosis. Different materials can be used for reconstruction, for example, the skin from the penis and scrotum, free flaps from the inner thigh, or buccal mucosa. Doctors abroad always transplant vascularized (with blood supply) flaps to avoid necrosis of the urethral wall, the formation of strictures and fistulas, and penis deformity.

Where to undergo your treatment of a fracture of a penis with a rupture of the urethra?

You can seek treatment in one of the countries with a high level of medicine. Treatment abroad will allow you to get the best results, maintain your erection, and avoid any repeated surgical procedures in the future. Doctors at foreign Urology Centers use advanced methods of treatment. Hospitals in developed countries have state-of-the-art equipment and the best specialists at their disposal, so here you can get top-class medical services.

There are a few reasons for you to undergo your treatment abroad. These are the following:

• high-precision diagnostics for assessing the nature of the injury and planning surgery;
• the use of modern options for the treatment of a fracture of a penis with a rupture of the urethra; 
• doctors use intraoperative diagnostic examinations to identify even small areas of tunica albuginea rupture;
• suturing is followed by tests to assess suture tightness, which reduces the risk of unsuccessful operations;
• as a result of the treatment of a fracture of a penis with a rupture of the urethra, you will get a good aesthetic result;
• erectile function preservation;
• the urethra can be completely restored without the formation of any fistulas, strictures, or other complications.

You are welcome to visit the Booking Health website to find out the cost of treatment at different hospitals and make an appointment for your treatment of a fracture of a penis with a rupture of the urethra at a favorable price. Our employees will provide you with quality travel organization services. The specialists at the Booking Health company will help arrange your urgent treatment abroad. When you choose medical services through the Booking Health website, the cost of treatment will be lower than when you contact the hospital directly. Prices are reduced due to the absence of taxes for foreign patients. The initial cost of treatment will not increase after the start of your treatment program, as when you make an appointment for your treatment abroad through Booking Health, you will receive insurance against unforeseen medical expenses.

Authors: 

The article was edited by medical experts, board-certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

Sources:

Medscape

PubMed

Healthline