PENILE FRACTURE IN A DEVELOPING ENVIRONMENT

Fracture of the penis is an acute surgical emergency of the penis associated with sexual intercourse, self manipulation and at times, may be accidental. The force of trauma is easily transmitted through the stretched tunica albuginea from 2mm thickness to 0.2mm and so offers no buffer to the engorged corpora cavernosa and the urethra. The pathology is a combination of rupture of the tunica albuginea and the ipsilateral corpus cavernosum; the urethra and both corpora cavernosa could be involved depending on the severity of the force applied. Clinically, it is characterised by a ‘pop’ sound, pain, rapid detumescence, swelling/deformity, angulation and when the urethra is involved, blood at the tip of the penis. The patient often looks subdued and ashamed by the exposure the hospital environment provides. It has been reported in our environment and no social class is exempt1,2. The seminal work of Ekeke et al3 in this issue of the Journal of the West African College of Surgeons has shown the pattern, management and good outcome in the 21 patients they treated within eight years in the Niger Delta region of Nigeria. The condition is relatively uncommon and the shame that may go with it makes some patients to present late for treatment, and in some cases, may not seek care at all.

With high index of suspicion and the classical clinical features the diagnosis is hardly a challenge. Ultrasonography which is readily available in the West African sub-region, provides definitive diagnosis and even grades the injury to the tunica albuginea, corpus cavernosum and the urethra4. Conservative treatment is associated with both short term and long term morbidity. Prompt surgery to repair the ruptured corpus cavernosum, the tunica albuginea and even the urethra with fine absorbable sutures is rewarded with good outcome1,2,3,4.