- What is Repair (Injury)
- Effects of Repair (Injury)
- Candidates for Repair (Injury)
- Your Consultation
- The Repair (Injury) Procedure
What is Repair (injury)?
Effects of Repair (injury)
Candidates for Repair (injury)
Three types of incisions are generally employed for the repair of penile trauma: incision directly over the defect, circumscribing-degloving incision, and inguinal-scrotal incision. You may want to discuss these options with your personal urologist. Follow-up with your personal physician is essential.
The Repair (injury) Procedure
A circumferential subcoronal incision provides exposure after penile fracture and most penetrating injuries of the shaft and permits corporal and urethral repair. The superficial layers and skin are bluntly degloved back to the base of the penis. For deeper injuries, proximal to the suspensory ligament or in the crura, a penoscrotal or perineal incision is required to provide access to the corpus cavernosum. Rupture of the corpus cavernosum as a result of a fracture, a stab wound, or a bullet wound is signaled by the presence of active bleeding and a defect in the fibrous tunica albuginea. Careful exploration and inspection of the corpus spongiosum are mandatory, even if urethrography shows no extravasation. Tunical ruptures caused by fracture are transversely oriented [see Figure 16 — omitted] and sometimes extend behind the spongiosum; this structure may have to be mobilized and retracted for adequate visualization of the injury.
The tunica albuginea is closed with interrupted 3-0 slowly absorbable sutures. Debridement and curettage have occasionally been used in this setting but generally are reserved for late presentations. Skin closure is possible with most penetrating injuries to the penis. The extensive vascular supply to the skin is rarely compromised. Interrupted chromic sutures provide a cosmetic closure and allow drainage of residual blood between the sutures.
A lightly compressive dressing is sufficient; tight wraps are to be avoided because they may lead to necrosis of swollen shaft skin. Catheter drainage is mandatory if urethral injury is present.
Risks for any anesthesia are reactions to medications and problems breathing. Risks for any surgery are bleeding and infection. The most common complication is swelling of the penis which usually resolves within a few days.
What causes fracture to the penis?
Fracture of the penis is an uncommon pathology. It consists in a rupture of the tunica albuginea of one or both corporacavernosa following injury to an erect penis. The most common causes are blunt trauma during sexual intercourse, masturbation, unconscious nocturnal penile manipulation or a fall onto the erect penis.
What happens when a penis fractures?
All patients refer to have heard a characteristic “cracking sound” during intercourse followed by immediate loss of erection, onset of severe pain and swelling of the penis. The subsequent penile hematoma which formed, brought about penile deformity and discoloration, which differed in severity from patient to patient.
What happens during the repair procedure?
Principles of surgical therapy are as follows:
- Optimize the surgical exposure
- Evacuate the hematoma
- Identify the site of injury
- Correct the defect in the tunica albuginea
- Repair the urethral injury
What are the benefits of surgical repair?
Microsurgical repair techniques have certain advantages, including better preservation of the penile shaft skin and the possibility of a sensate glans and normal orgasmic function.
What should I do after surgery?
Immediately after surgery, the penis is securely taped to the abdomen to for stability. Medications may be given to relieve pain. You are encouraged to take fluids to maintain urine output to avoid pressure on the urethra. Hospitalization is usually 2 to 3 days. Lots of fluids and frequent urination should continue after release from the hospital. Strenuous activity should be avoided until the surgical repair is fully healed.