Evaluation and treatment of penile fractures: accuracy of clinical diagnosis and the value of corpus cavernosography.

摘要

OBJECTIVES: To assess the accuracy of clinical diagnosis and feasibility of treatment on the basis of cavernosographic findings in men with clinical features consistent with penile fracture. METHODS: Forty consecutive patients (mean age 32 years, range 18 to 65) who presented with a history of blunt penile trauma and clinical signs and symptoms indicating penile fracture during the past 11 years were included. The charts of the first 13 patients, who were seen between 1990 and 1994 and were treated surgically on the basis of the clinical findings, were reviewed retrospectively. In the next 27 patients, a prospective study was designed and treatment was determined according to their cavernosogram findings: 21 with evidence of corporal injury treated surgically and 6 with normal imaging treated conservatively. The follow-up ranged from 3 to 32 months (mean 14). RESULTS: The clinical diagnosis of penile fracture was accurate in 11 of 13 patients and was false in 2 (15%). In the prospective study, corporal injury as determined by cavernosography was confirmed surgically in all cases. The cosmetic and functional results were satisfactory in all, including the patients treated conservatively. No serious complication was reported. CONCLUSIONS: In men with blunt penile trauma, the clinical presentation can be misleading and may result in unnecessary surgery. The results also demonstrated that cavernosography is a useful investigation method and may be helpful in selecting the treatment approach in these cases.