A man has had the dubious honour of having his triple penis fracture documented as a ‘rare case report’ by the surgeons attending.
A diagnosis of penile fracture, itself uncommon, is clinically based on typical signs and symptoms – including pain and swelling of the penis preceded by a snap sound, followed by rapid detumescence – but rarely involves all the three erectile bodies, the two corpora carvenosa and the corpus spongiosum.
Published last month in the International Journal of Surgery Case Reports, the report outlined how a 36-year-old male presented to a public health facility and teaching hospital in Tanzania, with complaints of penile swelling, pain, and blood coming from his urethra for the past five hours.
“The patient reported that while he was performing sexual intercourse with his female partner, he heard a sudden ‘snap’ sound when the penis slipped out, lost the way, and hit the female perineal area as he was trying to re insert it back,” the surgeons said.
“The sound was followed by rapid loss of erection, pain, blood per urethra and swelling of the penis. He went to a nearby health centre where he was given analgesia and referred to our health facility.
“On arrival, the patient was in mild pain, had swollen circumcised penis, a bit twisted and blood on the external urethral meatus.”
Magnetic Resonance Imaging (MRI) of the penis showed a ventral mid-penile tear from left to right through the tunica albuginea, corpus spongiosum, corpora carvenosa and partially through the urethra, and a hematoma measuring 3.13 cm by 2.7 cm in size was seen below the bucks fascia in the mid right aspect of the penis.
The patient was taken for emergency surgical exploration, followed by the repair of the penile fracture, with the final work on the urethral injury performed by a urologist.
The patient recovered well and was allowed home three days after the operation, with the urethral catheter removed after 21.
He was seen at the clinic six-months post-operative, by which time the penile shaft appeared normal, with no hardening of the tissue around the injury, and the patient reported to have resumed his sexual life without any difficulties.
The tunica albuginea is a tough structure formed by the two laminar which cover the corpora cavernosum and corpus spongiosum, that has a variable thickness depending on its location, such as being thinner on the ventral lateral aspect of the corpora.
Despite its variable thickness, it can resist tension of up to 1,500 mmHg. With a flaccid penis, the tunica albuginea is thicker, but its thickness decreases by 87.5 % when it becomes erect – as such, any cause of sudden increase in intra-coporal pressure could result in a rupture occurring in an erect penis.
When they occur, penis fractures are unilateral in 91.2 % of cases, with bilateral injury accounting for just 5–14% of incidents.
“Our case had a partial bilateral injury of the corpora cavernosum and the corpus spongiosum with involvement of the enclosed urethra,” the surgeons said.
“The impact of hitting the perineum might have been very high and hence lead into a very high intracorporal pressure to cause such a serious rupture involving the three corpora as well as the urethra.
“Although the diagnosis of penile fracture is clinical, MRI can help in the diagnosis and in delineating the extent of the injury, and urgent surgical repair of triple penile fracture showed an excellent outcome – including the recovery of erectile function.”
The case report is available at:
https://www.sciencedirect.com/science/article/pii/S2210261223003735?via%3Dihub