233Archivio Italiano di Urologia e Andrologia 2016; 88, 3 CASE REPORT Non sex-related subtotal rupture of the corpus cavernosum without urethral injury: A case report and literature review Zeki Bayraktar, Selami Albayrak Department of Urology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey. Although penile fracture is a rare case, it is a well-described urologic emergency. It results from the rupture of the tunica albuginea of corpora cavernosa by blunt strain that commonly mandates immedi- ate surgical exploration. Urethral injury may also accompa- ny penile fracture. An ideal anamnesis and a special physi- cal examination were determinant to achieve a correct diag- nosis. It is usually diagnosed based on clinical examination, but ultrasonography can be very helpful in diagnosis. The treatment is based on the presence of associated urethral injury. Early surgery is preferable to conservative manage- ment, because it is associated with better outcomes and fewer long-term complications. The surgical repair of cav- ernous body can produce good results, with a favorable prognosis and minimal rate of complications. We present a penile fracture case of 34-year-old with subtotal rupture of the right corpus cavernosum without urethral injury who treated by early surgery and good results. KEY WORDS: Penile fracture; Rupture; Diagnosis; Treatment; Surgery. Submitted 12 April 2016; Accepted 22 May 2016 Summary No conflict of interest declared. examination, there was swelling and subcutaneous hematoma in the penis (on the right penis skin). The defect at the fracture site was palpable. No hematoma was in the scrotum and pubis. Penis presented left-sided deviation (Figure 1). There was no urethral discharge and also no microscopic hematuria was found in the urine analysis. Patient did not declare dysuria or any other urination problem. Penile ultrasonography showed the presence of haematoma in the proximal shaft of the penis (30 x 21 mm) with a rupture of the tunica albug- inea of the right cavernosal corpora (10 mm) and oede- ma of the subcutaneous tissue. Cavernosal bleeding from the albugineal tears was showed at penile color Doppler ultrasonography. The patient was a healthy man with no medications or allergies. He was taken to the operating room for emergency surgery. Under the general anesthe- sia, penile subcoronal circumcising incision was made and the penis degloved. Hematoma was limited by Buck fascia (Figure 2). Fascia was incised and hematoma was evacuated (Figure 3). DOI: 10.4081/aiua.2016.3.233 Figure 1. Penis presenting left-sided deviation. Figure 2. Hematoma limited by Buck fascia. INTRODUCTION Penile fracture is a urological emergency which is caused by the rupture of the tunica albuginea of the corpus cav- ernosum following a blunt trauma to the erect penis (1). Tunical rupture caused by non-physiological bending of the penile shaft can be in one or two corpus cavernosum and it may be accompanied by urethral injury. The inci- dence of concomitant injury of the urethra is 0-38% in literature (2). We report the surgical repair of a penile fracture includ- ing subtotal disruption of corpus cavernosum without urethral injury. In this case, despite there was a subtotal rupture of the right corpus cavernosum, no urethral injury was observed. CASE REPORT A 34 -year-old man presented with rapid detumescence, acute penile pain, penile swelling and deviation to left side following a cracking sound at penile manipulation 2 hours before in January 2016. The patient was married. But he did not declare sexual intercourse. On physical Bayraktar_Stesura Seveso 21/09/16 09:04 Pagina 233 Archivio Italiano di Urologia e Andrologia 2016; 88, 3 Z. Bayraktar, S. Albayrak 234 There was subtotal transverse tears on the right tunica albuginea/corpus cavernosum. There were complete rupture on ventral, medial and later- al walls of the right corpus cavernosum. Only a part of dorsal wall of the right corpus cavernosum was not ruptured (Figure 4). A 18-French urethral catheter was passed into the bladder. Defect/rupture of the right corpus cavernosum was repaired by interrupted 3/0 vicryl sutures (Figure 5). For leakage control, artifical erection was provided by saline injected into the right corpus cavernosum. There was no leakage. Urethral catheter was removed at postoperative first day and the patient was discharged with oral antibiot- ic treatment. The patient was advised to abstain from sexual intercourse for at least 4 weeks. One month after surgery, the patient was clinically evaluated for the presence of erectile dys- function and penile deformity. Despite of the ban on sexu- al intercourse, the patient declared sexual intercourse at postoperative twenty-third day. There was no penile defor- mity in physical examination. Only a minimal induration was palpated at the fracture repair line. Patient had normal erectile and voiding functions. No problem such as pain and curvature in erection was declared by patient. Discussion and Supplementary References are posted on www.aiua.it CONCLUSIONS Penile fracture is a rare condition and is generally diag- nosed by clinical findings. Ultrasonography is a useful technique for confirmation of clinically suspected corpus cavernosum rupture and most often is sufficient for diag- nosis (3). Some cases may also be treated as a cosmetic, emergency surgical exploration and treatment is the best guarantee of good functional and cosmetic results. Early surgery has a high success rate and low complication in penile fracture. REFERENCES 1. Eke N. Fracture of the Penis. Br J Surg. 2002; 89:555-65. 2. Kamdar C, Mooppan UM, Kim H, et al. Penile fracture: preop- erative evaluation and surgical technique for optimal patient out- come. BJU Int. 2008; 102:1640-44. 3. Koifman L, Barros R, Júnior RA, et al. Penile fracture: diagnosis, treatment and outcomes of 150 patients. Urology. 2010; 76:1488-92. Figure 4. Rupture almost complete of the dorsal wall of the right corpus cavernosum. Figure 5. Repair of the defect/rupture of the right corpus cavernosum by interrupted 3/0 vicryl suture. Correspondence Zeki Bayraktar, MD (Corresponding Author) zbayraktar@medipol.edu.tr Istanbul Medipol University, School of Medicine, Department of Urology, Medipol Sefaköy Hospital Tevfikbey Mah. Maslakçeşme Cad.No:30 Küçükçekmece, Istanbul, Turkey Selami Albayrak, MD salbayrak@medipol.edu.tr Istanbul Medipol University, School of Medicine, Department of Urology, Istanbul, Turkey Figure 3. Fascia incision and hematoma evacuation. Bayraktar_Stesura Seveso 21/09/16 09:04 Pagina 234