![]() PD is considered an acquired inflammatory condition, and this opinion is supported by histopathological examination that shows the existence of perivascular inflammatory processes in the loose connective tissue located between the tunica albuginea and penile erection tissue causing the formation of plaque. Clinical history assessment and physical examination revealed a penile fracture with underlying PD. The tunica albuginea defect and plaque of PD was not palpable at the left side of the penis shaft, which might be the cause of the edema. The penis was angulated to the left with edema and local hematoma formation (Fig. Nowadays, on physical examination, the patient had normal vitals signs. This plaque was hard in consistency, and when erect, the patient’s penis had a 20° curvature, so we decided for nonsurgical management. On examination, there was a plaque of 2 × 1 cm present along the left side of the shaft of the dorsal penis, just proximal to the glans. Three years previously, he had a PD with a chief complaint that his penis deviates toward the left with painful erection, but no erectile dysfunction. He provided a clear history of rough sexual intercourse, heard a cracking sound from his penis, and slippage of the penis out of the vagina followed by rapid detumescence. Here, we report the case of a patient with penile fracture and underlying PD.Ī 47-year-old patient attended an ED with severe pain and had a history of penile injury following sexual intercourse close to 4 h ago. Penile curvature in men with PD caused by tunic anchoring plaques with loss of focal fiber elasticity will increase the risk of penile fracture during sexual activities due to reduced elasticity and erect penile orientation, which can cause trauma during vaginal penetration. Surgical management is only considered in severe cases after the fibrotic process has stabilized (approximately 12 months). The management of evolving or early phase PD is conservative and nonoperative. This microvascular shear injury leads to inflammation, fibrin deposition, fibroblast activation, and results in the formation of a fibrous scar. Although the etiology of PD remains unclear, several theories have been proposed, and penile trauma is a widely accepted hypothesis. In 1743, PD was first described by Francois de la Peyronie as “rosary beads” of scar tissue, causing an upward curvature of the penis during erections. Peyronie’s disease (PD) is a fibrotic disorder of the tunica albuginea in the penis. Penile fracture might also affect the corpora cavernous, corpus spongiosum, or urethra. Most commonly, penile fracture involves one side of the corpora cavernosa. Less common etiologies include reversing an erect penis during sleep, being kicked by animals, forced bending, a direct blow, gunshot wounds, or hastily removing or applying to clothing when the penis is erect. Penile fracture is among the most serious urological emergencies and is caused by a tear in the tunica albuginea and enclosed corpus cavernosum, which is often caused by anal intercourse, vigorous vaginal intercourse, masturbation, or any mechanical trauma that causes forcible bending of an erect penis. The first penile rupture case was reported in 1957 by Fernostrom, who recommended surgical intervention after prolonged observation. Penile plication might be necessary in severe cases (angulation > 60°). Penile fracture in a patient with underlying PD is a rare urological emergency that should be treated surgically with fracture repair as early as possible. Penile plication was not necessary for our case because the angulation of the penis was less than 15° after examination of artificial erection. He underwent emergency surgical exploration via subcoronal incision. We present a case of penile fracture in a male with a history of PD referred to the emergency department with severe pain. Immediate surgical treatment is the current standard of care and has a relatively low risk of late complications. Generally, a patient presented to a surgical emergency within 48 h of injury can be handled successfully with minimum complications. Penile fracture is the result of tearing of the tunica albuginea of one or both corpora cavernosa, usually during sexual intercourse, and is among the most serious urological emergencies. Penile curvature in men with Peyronie’s disease (PD)-caused by tunica anchoring plaques with loss of focal fiber elasticity-theoretically increases the risk of penile fracture during sexual activity. ![]()
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