![]() ![]() 12 Some patients have likened the sound to the snapping of a corn stalk or glass rod. 11 Patients commonly report hearing a “pop” or cracking sound from the erect penis at the moment of injury. Penile fractures are commonly diagnosed from their stereotypical clinical presentation. On the basis of his clinical presentation, the patient was taken to the operating room urgently for exploration and repair of an acute penile fracture. A retrograde urethrogram did not demonstrate any urethral injury. His urinalysis was normal, without evidence of microscopic hematuria. The penile shaft lacked a palpable defect, rolling sign, or hematoma, but the scrotum was markedly ecchymotic and tender. His penis was symmetrically swollen on examination, and there was no blood at the meatus. Upon presentation to the emergency department, he was voiding well and denied gross hematuria. He rapidly developed swelling of his scrotum and significant pain in his penoscrotal region. Upon injury, he heard a “pop” from his penis, and rapidly experienced acute penile pain and detumescence. His injury occurred when his penis slipped from the vagina and was forcefully thrust against his partner’s perineum. 7, 9, 10Ī 29-year-old, healthy African-American man presented to the emergency room for acute scrotal pain and swelling lasting 12 hours after traumatic intercourse. 6 Other rare reports in the world literature include cases resulting from banging an erect penis against a toilet, masturbating into a cocktail shaker, and placing an erect penis into tight pants. 6 In Iran, only 8% of the cases were attributed to sexual intercourse the remaining cases were due to self-manipulation and potentially fabricated events, such as a donkey bite to the erect penis, a man falling from a mountain onto his erect penis, and a brick falling onto an erect penis. 8 A majority of the cases in Mediterranean countries are the result of patients kneading and snapping their penis during erection to achieve detumescence. ![]() 7 In Japan, only 19% of cases are attributed to sexual intercourse, with the majority of cases reported as the result of masturbation and rolling over in bed onto an erect penis. In the United States, the majority of cases are the result of traumatic coitus, usually from thrusting an erect penis against the symphysis pubis or perineum. 5 The largest single series to date describes 172 cases over 9 years in a single province of Iran. A review by one investigator identified more than 1600 cases in the world literature, with more than half of those cases originating from Muslim countries. 4 Although initially regarded as a relatively rare injury, fracture of the penis is an increasingly reported genitourinary trauma. The first case of a penile fracture was described in the literature in 1924. In contrast, the tunica of the erect penis thins to approximately 0.25 mm on expansion, and the firmly engorged corpora under the strain of buckling can generate pressures in excess of 1500 mm Hg and exceed the limit of the thinned tunica. 1, 2 Anatomically, the flaccid penis lacks a fulcrum for snapping and contains relatively thick tunica albuginea, protecting it from internal rupture under strain. Although similar cavernosal lacerations to the flaccid penis have been reported as the result of gunshot traumas and sporting injuries, it is accepted that injuries to the flaccid penis should not be regarded as “fractures,” owing to the different nature of the injury. ![]() The diagnosis of “penile fracture” specifically refers to a rupture of the corpus cavernosum induced by blunt trauma to the erect penis. ![]()
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