Saturday night, Mbah Dukun Bagong's neighbour made conversation with mbah dukun Bagong, he asked can the penis get injury like fracture and if it can happened, what the treatment. Mbah Dukun explained fully convincing
DEFINITIONS
Fracture penis is a rupture of one or both corpora cavernosum of the penis with or without corpus spongiosum as blunt trauma in the erect penis. This is common in sexual hard, masturbation, or deflect the force an erect penis
.
During coitus, normal size of thickness of the tunica albuginea is 2 mm be thinned to 0.25 mm. forcibly bending penis is very possible occurrence of rupture. Both corpora cavernosum rupture can occur, can also rupture the corpus spongiosum which is wrapped around the urethra corpus, if this happens to make urethral rupture.
EPIDEMIOLOGY
Fracture penis is a rare urological emergency, first reported in 1924, a total of 183 reports have been published with 1331 cases since 1935 until 2001. Over the past 8 years (1987-1995) 12 incidents of Fracture penis have been reported. And in the years 1982-2002 have been reported 56 patients with Fracture penis.
In the year 1986-1987 reported a surgical repair in 8 cases of Fracture penis. Malik et al in his research found the average age in 11 patients with Fracture penis is at the age of 19-56 years. In Western countries the most common cause is sexual intercourse, whereas in the Middle East and Mediterranean countries the most common cause is masturbation.
ETIOLOGY
Fracture penis is a rupture of one or both corpora cavernosum of the penis with or without corpus spongiosum as blunt trauma in the erect penis. This is common in sexual hard, masturbation, or deflect the force an erect penis
.
During coitus, normal size of thickness of the tunica albuginea is 2 mm be thinned to 0.25 mm. forcibly bending penis is very possible occurrence of rupture. Both corpora cavernosum rupture can occur, can also rupture the corpus spongiosum which is wrapped around the urethra corpus, if this happens to make urethral rupture.
EPIDEMIOLOGY
Fracture penis is a rare urological emergency, first reported in 1924, a total of 183 reports have been published with 1331 cases since 1935 until 2001. Over the past 8 years (1987-1995) 12 incidents of Fracture penis have been reported. And in the years 1982-2002 have been reported 56 patients with Fracture penis.
In the year 1986-1987 reported a surgical repair in 8 cases of Fracture penis. Malik et al in his research found the average age in 11 patients with Fracture penis is at the age of 19-56 years. In Western countries the most common cause is sexual intercourse, whereas in the Middle East and Mediterranean countries the most common cause is masturbation.
ETIOLOGY
The most common cause fracture of the penis is trauma during coitus, other causes are masturbation, nocturnal penis manipulation did not realize or to reduce the erection, penis erection knock down with a blunt object, or penis is caught in tight pants. Most (75%) occurred on one side, 25% on both sides, and 10% of them involving the urethra.
Generally, patients complain of Fracture penis due to coitus with a partner on top position astride the body of the penis. When coitus penis out of the vagina and when will put back the penis hit the pubis or perineum. All patients reported a typical crack sound ("Cracking sound") followed by loss of erection, severe pain, penis edema and discolored, and deformed penis.
PATHOPHYSIOLOGY
At the time of erection arterial blood flow to the penis, causing the corpus cavernosum and spongiosum enlarged longitudinal and transverse direction so that the penis becomes hard and its mobility is reduced, the tunica albuginea is thinner than 2 mm reach 0.5 - 0.25 mm, so easily torn if there is trauma. The penis will swell, hematoma, pain, and bent in the opposite direction from the side of the fracture. Hematoma is usually confined to Buck's fascia, if Buck's fascia hematoma can get involved then get to the scrotum, perineum anterior, and lower abdominal wall.
DIAGNOSIS
a.Anamnesis
Generally, patients complain of Fracture penis due to coitus with a partner on top position astride the body of the penis. When coitus penis out of the vagina and when will put back the penis hit the pubis or perineum. Patients hear the sound of a typical crack (cracking sound) is followed by an ever-greater pain increases, the pain spread to the lower abdomen when driven. Patients also complained of pain during urination.
Patients complain of sudden penis swelling and increasingly expanding. followed by loss of erection, severe pain, penis edema and discolored, and deformed penis ..
b. Physical Examination
On physical examination found penis hematoma, penis deviation, penis swelling significantly. ecchymosis penis can occur if the buck's fascia is not intact, visible ecchymosis formation of butterfly-pattern if the fascia COLLES not intact.
The penis looks swollen and bruised. If Buck's fascia rupture then bruises will extend to the lower abdominal wall, into the perineum and scrotum. Pain will be felt on palpation in the area tearing of tunica albuginea. If the urethra is damaged it will be followed by the discharge of blood through the urethra or meatus occurred hematuria microscopic. Can also occur gross haematuria, painful urination, and urinary retention.
Sometimes patients present with a history of pain during intercourse, and swelling of the penis, but when checking on the tunica albuginea remained intact, in this case caused by hematoma due to rupture of the dorsal penis vein that required handling of simple ligation of venous rupture.
c. Additional Examination
If there is blood in the urine or if the patient complained of pain or difficulty urinating, do retrograde uretrogram to see the rupture urethra. Agrawal et al. (1991) recommends urethrography in all cases of Fracture penis.
Cavernosography is used intracorporeal injection of contrast to see a fracture, ultrasound is used to confirm the diagnosis is uncertain. Magnetic resonance imaging (MRI) can accurately demonstrate the location of rupture, but this is just a very complex way to investigate a condition in which the diagnosis is generally obvious from anamensa (sounds cracked, detumesence sudden, and pain during intercourse) and clinical examination (swelling and bruising of the penis).
In general, in the case of Fracture penis is not needed investigation, but in cases where the etiology and physical examination are not balanced, and uretrogram cavernosogram can be done.
TREATMENT and THERAPY
a) conservative
First, the management of Fracture penis with the use of conservative penis splint, cold compress, analgesic drugs, NSAIDs and absent from sexual intercourse for 6-8 weeks . This therapy slowly changed since 1986, 80% of patients following surgery Fracture penis
Jallu et.al reported 4 cases of Fracture penis that did well with conservative treatment of Oxyphenbutazone 3 x 200 mg and diazepam 10 mg orally 3 times daily for 2-3 weeks. But many authors who advocate immediate exploration to take action. Conservative management is indicated only for patients who are unable to receive anesthesia, no surgical facilities and surgical team, the reluctance of patients to surgery and a history of penis trauma but normal on physical examination found no abnormalities .
Operative therapy is better than conservative therapy. In several studies have reported 10-41% of patients experienced complications with conservative management. Other researchers reported conservative therapy provides 25-53% of complications. Complications may include blood clot, curvatura abnormal on the penis, infection, penis abscess, persistent extravasation of urine, pain on erection and erectile dysfunction. No postoperative complications occurred and generally does not affect sexual activity in the future. Length of stay in hospital about 14 days compared with operative treatment - average 6.6 days.
b) Operative
Surgery is the primary choice in Fracture penis haematoma with severe clinically.
The principle of surgery consisted of open hand fractures in the tunica albuginea, evacuation of haematoma, and closing the tunica damaged. The location of fracture can be opened by degloving the penis through an incision around the sulcus circumcision subcoronal.
As an alternative, a incisi can be made directly over the defect, with the assumption that the degree of swelling is not too big. if there is a urethral trauma, degloving generally allow exposure to repair the urethra. An alternative is a midline incision of the distal midline raphe scrotum to the penis along the shaft.
Incision with degloving incision to expose both corpora cavernosum so that if any other unexpected bilateral trauma can be fixed easily.
Preoperative catheter placement remains controversial, there is suggesting as a routine action after the physical examination there was no sign - a sign of urethral injury. Installation of the catheter facilitate intraoperative dissection without injuring the urethra and prevent postoperative wound contamination.
Exploration action with circumscibbing degloving incision and exposure of the corpus cavernosum and corpus spongiosum, followed by hematoma evacuation, and identification of tears to the tunica albuginea. Tear in a 3-0 Vicryl suture with interruptus, leather stitched with "chromic catgut" in interuptus 3-0.
All patients treated for 5 days in good condition. Follow-up to 6 weeks, there was no deformity of the penis, the penis can be erect with straight without pain and coitus can be done well.
COMPLICATIONS
In several studies have reported 10-41% of patients experienced complications with conservative management. Other researchers reported conservative therapy provides 25-53% of complications. Complications may include blood clot, curvatura abnormal on the penis, infection, penis abscess, persistent extravasation of urine, pain on erection and erectile dysfunction. No postoperative complications occurred and generally does not affect sexual activity in the future.
Prognosis
Patients who were treated with conservative at high risk of complications. No postoperative complications occurred and generally does not affect sexual activity in the future
Generally, patients complain of Fracture penis due to coitus with a partner on top position astride the body of the penis. When coitus penis out of the vagina and when will put back the penis hit the pubis or perineum. All patients reported a typical crack sound ("Cracking sound") followed by loss of erection, severe pain, penis edema and discolored, and deformed penis.
PATHOPHYSIOLOGY
At the time of erection arterial blood flow to the penis, causing the corpus cavernosum and spongiosum enlarged longitudinal and transverse direction so that the penis becomes hard and its mobility is reduced, the tunica albuginea is thinner than 2 mm reach 0.5 - 0.25 mm, so easily torn if there is trauma. The penis will swell, hematoma, pain, and bent in the opposite direction from the side of the fracture. Hematoma is usually confined to Buck's fascia, if Buck's fascia hematoma can get involved then get to the scrotum, perineum anterior, and lower abdominal wall.
DIAGNOSIS
a.Anamnesis
Generally, patients complain of Fracture penis due to coitus with a partner on top position astride the body of the penis. When coitus penis out of the vagina and when will put back the penis hit the pubis or perineum. Patients hear the sound of a typical crack (cracking sound) is followed by an ever-greater pain increases, the pain spread to the lower abdomen when driven. Patients also complained of pain during urination.
Patients complain of sudden penis swelling and increasingly expanding. followed by loss of erection, severe pain, penis edema and discolored, and deformed penis ..
b. Physical Examination
On physical examination found penis hematoma, penis deviation, penis swelling significantly. ecchymosis penis can occur if the buck's fascia is not intact, visible ecchymosis formation of butterfly-pattern if the fascia COLLES not intact.
The penis looks swollen and bruised. If Buck's fascia rupture then bruises will extend to the lower abdominal wall, into the perineum and scrotum. Pain will be felt on palpation in the area tearing of tunica albuginea. If the urethra is damaged it will be followed by the discharge of blood through the urethra or meatus occurred hematuria microscopic. Can also occur gross haematuria, painful urination, and urinary retention.
Sometimes patients present with a history of pain during intercourse, and swelling of the penis, but when checking on the tunica albuginea remained intact, in this case caused by hematoma due to rupture of the dorsal penis vein that required handling of simple ligation of venous rupture.
c. Additional Examination
If there is blood in the urine or if the patient complained of pain or difficulty urinating, do retrograde uretrogram to see the rupture urethra. Agrawal et al. (1991) recommends urethrography in all cases of Fracture penis.
Cavernosography is used intracorporeal injection of contrast to see a fracture, ultrasound is used to confirm the diagnosis is uncertain. Magnetic resonance imaging (MRI) can accurately demonstrate the location of rupture, but this is just a very complex way to investigate a condition in which the diagnosis is generally obvious from anamensa (sounds cracked, detumesence sudden, and pain during intercourse) and clinical examination (swelling and bruising of the penis).
In general, in the case of Fracture penis is not needed investigation, but in cases where the etiology and physical examination are not balanced, and uretrogram cavernosogram can be done.
TREATMENT and THERAPY
a) conservative
First, the management of Fracture penis with the use of conservative penis splint, cold compress, analgesic drugs, NSAIDs and absent from sexual intercourse for 6-8 weeks . This therapy slowly changed since 1986, 80% of patients following surgery Fracture penis
Jallu et.al reported 4 cases of Fracture penis that did well with conservative treatment of Oxyphenbutazone 3 x 200 mg and diazepam 10 mg orally 3 times daily for 2-3 weeks. But many authors who advocate immediate exploration to take action. Conservative management is indicated only for patients who are unable to receive anesthesia, no surgical facilities and surgical team, the reluctance of patients to surgery and a history of penis trauma but normal on physical examination found no abnormalities .
Operative therapy is better than conservative therapy. In several studies have reported 10-41% of patients experienced complications with conservative management. Other researchers reported conservative therapy provides 25-53% of complications. Complications may include blood clot, curvatura abnormal on the penis, infection, penis abscess, persistent extravasation of urine, pain on erection and erectile dysfunction. No postoperative complications occurred and generally does not affect sexual activity in the future. Length of stay in hospital about 14 days compared with operative treatment - average 6.6 days.
b) Operative
Surgery is the primary choice in Fracture penis haematoma with severe clinically.
The principle of surgery consisted of open hand fractures in the tunica albuginea, evacuation of haematoma, and closing the tunica damaged. The location of fracture can be opened by degloving the penis through an incision around the sulcus circumcision subcoronal.
As an alternative, a incisi can be made directly over the defect, with the assumption that the degree of swelling is not too big. if there is a urethral trauma, degloving generally allow exposure to repair the urethra. An alternative is a midline incision of the distal midline raphe scrotum to the penis along the shaft.
Incision with degloving incision to expose both corpora cavernosum so that if any other unexpected bilateral trauma can be fixed easily.
Preoperative catheter placement remains controversial, there is suggesting as a routine action after the physical examination there was no sign - a sign of urethral injury. Installation of the catheter facilitate intraoperative dissection without injuring the urethra and prevent postoperative wound contamination.
Exploration action with circumscibbing degloving incision and exposure of the corpus cavernosum and corpus spongiosum, followed by hematoma evacuation, and identification of tears to the tunica albuginea. Tear in a 3-0 Vicryl suture with interruptus, leather stitched with "chromic catgut" in interuptus 3-0.
All patients treated for 5 days in good condition. Follow-up to 6 weeks, there was no deformity of the penis, the penis can be erect with straight without pain and coitus can be done well.
COMPLICATIONS
In several studies have reported 10-41% of patients experienced complications with conservative management. Other researchers reported conservative therapy provides 25-53% of complications. Complications may include blood clot, curvatura abnormal on the penis, infection, penis abscess, persistent extravasation of urine, pain on erection and erectile dysfunction. No postoperative complications occurred and generally does not affect sexual activity in the future.
Prognosis
Patients who were treated with conservative at high risk of complications. No postoperative complications occurred and generally does not affect sexual activity in the future
