Snap sound and detumescence: Fracture penis

R Mongha, AK Kundu 
 Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata, India

Correspondence Address:
R Mongha
Department of Urology, Institute of Post Graduate Medical Education and Research, Kolkata
India

Full Text

Sir,

I read with interest the article by the authors, Rao A, Surendrababu. [1]

It is a straightforward case of penile fracture with typical history and presentation. Patient described a cracking sound during intercourse followed by pain, detumescence, discoloration, and swelling of penile shaft. Patient should have been immediately explored and magnetic resonance imaging (MRI) was not required in this case.

In cases of penile fracture, if the Bucks fascia remains intact penile hematoma remains confined within skin and tunica resulting in typical ("eggplant deformity"), a sign that is highly diagnostic. [2] If the Bucks fascia is disrupted, hematoma can extend to scrotum and perineum "butterfly sign." [3]

The typical history and clinical presentation of fracture penis usually make the adjunctive imaging studies unnecessary as was in this case. The major argument associated with the use of MRI is the time requirement involved with the study, limited availability of MRI in emergency hours, and the associated expense.

Immediate surgical reconstruction results in faster recovery, lower complication rates, and lower incidence of long-term penile curvature. Timing of surgery influences the long-term success significantly. Importance of time in penile fracture is more important as many of these patients already present late because of associated fear and embarrassment.

MRI is usually indicated in doubtful cases where there is penile swelling and ecchymoses without the classical history of snap-pop or rapid detumescence after the injury. The message in case of penile fracture should be prompt exploration and surgical repair.

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