Distinguishing penile ecchymosis from a true penile fracture, or a rupture through the tunical albuginea, can be a challenging clinical conundrum. A penile fracture typically occurs in the setting of blunt penile trauma to the erect penis, most often during sexual intercourse or masturbation. Physical examination findings may vary significantly in patients with a history suggestive of penile fracture, and the severity of the penile ecchymosis frequently does not correlate with the presence or absence of tunical rupture. This clinical picture can be even more confusing if the patient received collagenase clostridium histolyticum CCH in the days or weeks prior to presentation. Penile fracture is considered an urgent urologic condition that requires timely repair to prevent long-term complications of corporal fibrosis, penile curvature, chronic pain, and erectile dysfunction 3.
A penis fracture is a tear in a membrane in the penis called the tunica albuginea. This membrane surrounds the corpora cavernosa, the two long chambers that fill with blood when a man has an erection. Vigorous intercourse is one of the most common causes of penile fracture, especially in Western countries. Fracture can also happen if a man masturbates aggressively or rolls over his erect penis while sleeping. Men who practice this forcefully bend the shaft of an erect penis. Some men feel pleasure from it.
Penile fracture is a rare event, however requires emergency diagnosis and intervention. What a urologist needs to known in such an emergency, is to know whether tunica albuginea is ruptured and if its extent is up to the urethra. This will help to determine if an emergent surgical exploration is indicated, and what structures need to be repaired. Patients typically have a characteristic history of trauma in an erect penis: a 'crack' may be heard with associated severe pain, loss of erection and a suddenly swollen penis.
A penile fracture is a tear in the tunica albuginea. The tunica albuginea is the rubbery sheath of tissue below the skin that allows the penis to increase in width and length to produce a firm erection. Sometimes the erectile tissue beneath the tunica albuginea also ruptures.