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Penile fracture and external genital injuries
Penile fracture is a tear in the corpus cavernosum's tunica albuginea during erection and is treated with early surgical exploration and repair; a testicular rupture seen on ultrasound also requires early surgery to save the testis.
Why it matters in the exam
The exam shows a man who describes a "snap" during intercourse, rapid loss of erection, pain and swelling with discolouration of the penis ("aubergine") and deviation away from the tear. The diagnosis is clinical in most cases; imaging (ultrasound or MRI) is needed only when the picture is unclear. In some cases the urethra is also torn — blood at the meatus, haematuria or difficulty voiding — and then urethrography or cystoscopy is done and the urethra is repaired in the same operation.
Early repair reduces deformity, pain and poor erections compared with conservative treatment. In blunt testicular trauma with a large haematoma, with ultrasound showing a torn tunica albuginea or heterogeneous parenchyma, early exploration and repair is performed; the testicular salvage rate is much higher with early surgery. A large haematocele is also often treated surgically.
Penile amputation: wrap the amputated part in saline-soaked gauze, in a sealed bag placed on ice (not directly on the ice), and perform microsurgical replantation as early as possible, preferably within 24 hours. Human and animal bites are treated with irrigation, antibiotics and tetanus immunisation and rabies cover as appropriate. Extensive skin injuries (degloving) are treated with irrigation and skin graft cover. Rings stuck on the penis need removal with a suitable tool and evaluation of the urethra. A scrotal injury from a firearm or a blast requires surgical exploration in most cases, and in every penetrating genital injury urethral and vascular injury must also be considered.
Key points
- Penile fracture = tear of the tunica during erection.
- Early surgery improves outcome.
- Check the urethra.
- Testicular rupture — early exploration.
- Amputation — cold preservation and replantation within 24 hours.
Summary table
| Injury | Signs | Treatment |
|---|---|---|
| Penile fracture | Snap, loss of erection, "aubergine" | Early surgical repair |
| Fracture with urethral injury | Blood at the meatus, retention | Urethrography and repair in the same operation |
| Testicular rupture | Haematoma, torn tunica on ultrasound | Early exploration and repair |
| Penile amputation | Amputated part | Saline gauze, bag on ice, replantation within 24 hours |
| Bite | Contaminated wound | Irrigation, antibiotics, tetanus and rabies |
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Sources
- EAU Guidelines on Urological Trauma, 2025 edition — Genital trauma
- AUA Guideline: Urotrauma, 2020 — Genital trauma
- Campbell-Walsh-Wein Urology, 12th edition (2020) — Genital and Lower Urinary Tract Trauma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.