Volume 7, Issue 1 (8-2025)
Tabari Biomed Stu Res J 2025, 7(1): 61-72 |
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Rezaeimehr B, Younesi Rostami M, Faaliat S. Selective Imaging in Suspected Penile Fracture: A Narrative Review of Ultrasound, MRI, and Evaluation of Associated Urethral Injury. Tabari Biomed Stu Res J 2025; 7 (1) :61-72
URL: http://tbsrj.mazums.ac.ir/article-1-3921-en.html
URL: http://tbsrj.mazums.ac.ir/article-1-3921-en.html
1- Department of Urology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
2- Associate Professor of Endourology, Department of Urology, School of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
3- Medical Student, Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
2- Associate Professor of Endourology, Department of Urology, School of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
3- Medical Student, Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Abstract:
Penile fracture is a time-sensitive urologic emergency caused by rupture of the tunica albuginea of one or both corpora cavernosa, most often after abrupt bending of the erect penis. In a classic presentation, the combination of a characteristic mechanism, a cracking or snapping sensation, immediate detumescence, pain, swelling, and ecchymosis is usually sufficient for diagnosis, and routine imaging should not delay surgical repair. Imaging is most useful when the presentation is atypical, a false penile fracture is plausible, or preoperative localization may change the surgical approach. High-frequency ultrasound is the preferred first-line examination in equivocal cases because it is rapid, accessible, inexpensive, and capable of demonstrating focal tunical discontinuity and adjacent hematoma. Because its sensitivity is operator- and location-dependent, a negative or nondiagnostic ultrasound does not reliably exclude a small or proximal tear when clinical suspicion persists. MRI provides superior soft-tissue contrast and more precise tear mapping and is best reserved as a problem-solving examination for discordant, proximal, complex, or otherwise uncertain injuries. Associated urethral injury should be evaluated selectively rather than routinely. Blood at the urethral meatus, gross hematuria, voiding difficulty or retention, and bilateral corporal injury should prompt retrograde urethrography and/or flexible cystoscopy. A selective escalation pathway preserves rapid treatment for obvious fractures while reducing unnecessary imaging and avoidable exploration in mimics.
Keywords: Penile fracture, Ultrasonography, Magnetic resonance imaging, Tunica albuginea, Urethral injury, Retrograde urethrography, Cystoscopy
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