Management of penile fracture with complete urethral transection in a resource-limited setting: A case report.

Key Clinical Message: Penile fracture is a urological emergency that requires prompt surgical intervention for optimal outcomes. Early diagnosis based on clinical presentation and imaging if needed is crucial. Timely repair ensures the preservation of penile function and minimizes complications. Abstract: Penile fracture (PF) is a rare but significant urological emergency characterized by the rupture of the tunica albuginea, often resulting from blunt trauma during sexual intercourse or other activities. The typical presentation includes sudden and severe penile pain, an audible "cracking" sound followed by swelling and deformity. While PF generally does not involve the urethra, bleeding from the urethral meatus suggests an associated urethral lesion. Imaging such as ultrasonography or magnetic resonance imaging (MRI) can assess the extent of the injury. We report a case of a 28-year-old male who presented with sudden-onset penile pain, swelling, and blood dripping from the urethral meatus after a traumatic sexual encounter. The injury occurred during vigorous intercourse when his erect penis struck his partner's buttocks. He heard a cracking sound followed by immediate detumescence, penile curvature, and urethral bleeding. At the hospital, the patient exhibited tachycardia and elevated blood pressure. Examination revealed deviation of the penis to the right, urethrorrhagia, and a tender, swollen penis. A clinical diagnosis of bilateral corpora cavernosa injury and partial rupture of the penile urethra was made. A urethral catheter was placed with difficulty, draining initially reddish urine followed by clear urine. Laboratory tests showed normal hemoglobin and coagulation profiles with mild bacteriuria and hematuria. Due to clear clinical signs, no radiological imaging was performed before surgery. Surgical exploration performed 48 h postinjury revealed a PF involving the right corpus cavernosum and a complete rupture of the spongy urethra. The corpus cavernosum was repaired using Vicryl 2-0 sutures followed by urethroplasty with Vicryl 5-0. Postoperative care included antibiotics and analgesics. The patient had an uneventful recovery with preserved penile sensitivity and function. PF is a rare urological emergency that necessitates prompt diagnosis and management to prevent long-term complications. Although clinical presentation often suffices for diagnosis, imaging can be valuable in ambiguous cases. Surgical intervention is the preferred treatment, offering the best functional and cosmetic outcomes. This case underscores the importance of timely surgical repair to ensure favorable recovery and preservation of penile function.