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November 1997, Volume 47, Issue 11

Case Reports

Penile Fracture Due to “Rolling Over in Bed Injury”

A. Fawad  ( Ziauddin Medical University, Karachi. )
M. Hammad Athar  ( Ziauddin Medical University, Karachi. )

Traumatic rupture of the corpus cavernosum is an infrequently reported condition. The injury involves rupture of tunica albuginea of one or both corpora with or without rupture of urethra resulting from injury incurred to an erect penis. This commonly results from forcible manual deflection of an erect penis1, forceful attempt at vaginal penetration and hitting perineum, fall onto erect penis, sexual maneuvers etc. “Rolling over in bed” is a very rare etiology. Characteristically, a cracking sound is heard with sudden pain followed by detumescence, swelling and discolouration.

Case Report

A 26 years old married male presented to the emergency room at 0500 hours with complaints ofpainand swellingofthe penis of one hour duration, He was awoken by his crying one year old daughter sleeping in the same room. While rolling over in bed to reach for her, he heard a cracking sound and felt pain in his erect penis. He lost erection, the penis started to swell up and became discoloured (Figure 1).

He immediately reached the hospital. On examination, there was a grossly swollen penis with discolouration due to stasis, both corpora cavernosa and spongiosum were soft and there was no pain or tenderness. Keeping in view of the unequivocal history and physical examination findings a decision was made for operative repair of tunica albuginea and corpus cavernosum. Preliminary urethrogmm was skipped due to absence of gross or microscopic hematuna and ease in passing urine. A distal sub-coronal incision was given and penis degloved (Figure 2)

upto the level of the rent (mid shaft) which was repaired with 5/0 synthetic absothable suture (Viciyl TM). Patient was discharged two days later with good cosmetic and functional results in the post-operative follow-up.

Discussion

Traumatic rupture of the corpus cavernoswn due to disruption of covering tunicaalbuginea is rare. Penile fracture with urethral injuries is even rare. All reported cases occur following a blunt trauma to the rigid penis2. “Rolling over in bed injury" is a very infrequently reported cause of penile fracture3. Diagnosis is clinical and usually no preoperative radiological evaluation is necessary. Preoperative cavemosography is strongly recommended by some to demonstrate the site of injury and to aid in planning the surgical approach4. Incidence of urethral injury in the absence of hematuria is minimal, therefore, this examination is only done when indicated. Tunical tears occur most commonly during coitus, but rarely may also follow abnormal bending during masturbation and sex play. There is some controversy about management as some suggest conservative treatment5. Non-surgical management can, however, result in defonnity due to plaque and impaired tumescence due to corporeal fibrosis. Majority of recent reports tend to favour surgical therapy1.

References

1. Asgari, MA., Hosseini, S.?., Safarinejad, MR. et a!. Penile fracture: Evaluation, therapeutic approaches and long term results (see comments),J. Urol., 1996;155:148-149.
2. Wang, C.N., Huang, CH., Chiang, C.P. et a!. Recent experience of penile fracture (1989-1993). a-Hsiung-I-Huesh-Ko-Huesh-Tsa-Chih, 1995;11:654­659.
3. Klein, F.A., Smith, M.J. and Miller, N. Penile fracture: Diagnosis and management. J. Trauma, 1985;25:1090-1092.
4. Dever, OP., Saraf, PG., Catanese, RE et al. Penis fracture: Operative management and cavernosography. Urology, 1983;22:394- 396.
5. Kalash, S.S. and Young, JO. Fracture of penis: Controversy ofsurgicalversus conservative treatment. Urology, 1984;24:21 .24.

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