Editing Lower Urinary Tract Trauma (section)

===== Diagnosis and Evaluation =====

* '''<span style="color:#ff0000">Diagnosis of penile fracture can me made reliably by history and physical exam</span>'''

====== History and Physical Exam ======
* '''<span style="color:#ff0000">History</span>'''
** '''<span style="color:#ff0000">Indicators of penile fracture</span>'''
**# '''<span style="color:#ff0000">Penile ecchymosis or swelling</span>'''
**# '''<span style="color:#ff0000">Cracking, popping, or snapping sound during intercourse or manipulation and immediate detumescence.</span>'''
* '''<span style="color:#ff0000">Physical exam</span>'''
** '''<span style="color:#ff0000">Penis</span>'''
***'''<span style="color:#ff0000">Swollen</span>'''
***'''<span style="color:#ff0000">Ecchymotic</span>'''
****'''<span style="color:#ff0000">If Buck fascia remains intact, the penile hematoma remains contained between the skin and tunica, resulting in a typical “eggplant deformity.”</span>'''
**** '''<span style="color:#ff0000">If Buck fascia is disrupted, the hematoma can extend to the scrotum, perineum, and suprapubic regions (see above “butterfly hematoma”).</span>'''
***'''<span style="color:#ff0000">Fracture line in the tunica albuginea may be palpable</span>'''
***'''<span style="color:#ff0000">Deviates to the side opposite the tunical tear</span> because of hematoma and mass effect'''

====== Imaging ======
*'''<span style="color:#ff0000">Indication (1)</span>'''
**'''<span style="color:#ff0000">History and physical examination are equivocal for penile fracture</span>'''
***'''<span style="color:#ff0000">Usually unnecessary as diagnosis can often be made based on history and physical exam</span>'''
*'''<span style="color:#ff0000">Options (2):</span>'''
*#'''<span style="color:#ff0000">Ultrasound (preferred)</span>'''
*#* '''Preferred over MRI because it is rapid, readily available, noninvasive, inexpensive, and accurate'''
*#* Most useful for ruling out fracture in patients with low clinical suspicion or to identify the location of the tear, potentially guiding the choice of incision
*# '''<span style="color:#ff0000">Penile-perineal MRI</span>'''
*#* '''<span style="color:#ff0000">Most accurate test</span>'''
*#* '''Can be considered if ultrasound equivocal to prevent unnecessary surgical exploration'''.
** '''<span style="color:#ff0000">Both penile Doppler and cavernosography have very high false negative rates and are not recommended in the evaluation of suspected penile fracture.</span>''' [SASP 2016]
* '''<span style="color:#ff0000">If imaging is equivocal or diagnosis remains in doubt, surgical exploration should be performed</span>'''

====== Other ======
* '''<span style="color:#ff0000">Urethral evaluation (urethroscopy or retrograde urethrogram)</span>'''
** '''<span style="color:#ff0000">Urethral injury occurs in 10-22% of cases of penile fracture</span>'''
*** '''<span style="color:#ff0000">Bilateral corporeal injuries are more commonly associated with urethral injury</span>'''
**'''<span style="color:#ff0000">Indications</span>''' 
***'''<span style="color:#ff0000">Penile fracture or penetrating trauma with</span>'''
***#'''<span style="color:#ff0000">Blood at the urethral meatus</span>'''
***#'''<span style="color:#ff0000">Gross hematuria</span>'''
***#'''<span style="color:#ff0000">Inability to void</span>'''