Penile injury is rare. Very occasionally penile amputation - either self-inflicted or a "Bobbit" type injury will be encountered, and re-suture of the penis can be attempted in a specialised plastic surgical unit. Damage to the erect penis during sexual activity, so-called "fractured penis", is however more common.
Anatomy, Physiology And Pathology Of The Fractured Penis
Most of the bulk of the penis is made up of the erectile tissue - three tubes full of (usually) empty sinusoids and blood vessels. There are two large tubes called the corpora cavernosum, one on each side, and a thinner tube called the corpus spongiosum which surrounds the urethra in the midline dorsally. The erectile tissue is contained by thick coats of fibrous tissue with significant elastic properties - this tissue will normally withstand the very significant pressure that is generated from within caused the increased blood flow during an erection.
During sexual activity the penis, and in particular the corpora, are subjected to significant buckling forces. Normally these forces are resisted, but if the force is excessive, perhaps during vigorous and mistimed intercourse, the corpora will tear or "fracture".
Symptoms And Signs
When the penis fractures there is frequently an audible "crack" heard by both partners. The penis becomes flaccid, painful and bruised.
Treatment is surgical, and performed as soon as possible. Delayed treatment has been employed but usually results in scar tissue forming at the site of the damage to the corpora which causes a subsequent bend in the erection (see Peyronies disease). Conservative treatment also results in painful erections during the healing phase, unless they are suppressed by anti-androgens.
The penis should be explored under general anaesthetic through a subcoronal de-gloving incision. The tear in the corpora can usually be easily identified and is repaired with a slowly dissolving absorbable suture such as PDS. Any haematoma is evacuated and the incision is sewn up with a rapidly absorbable suture such as vicryl rapide.
The results of surgical treatment are excellent from both a cosmetic and functional point of view.
By Mr Michael Foster DM FRCS (Urol)