Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Penile Trauma and Miscellaneous Penile Lesions


Etiology

Penile lesions can be categorized by cause ( Box 76-1 ).

Box 76-1
From Bhatt S, Kocakoc E, Rubens DJ, et al: Sonographic evaluation of penile trauma. J Ultrasound Med 2005; 24:993–1000.
Penile Pathologic Processes

  • Trauma

  • Blunt trauma

  • Penetrating or sharp trauma

  • Acute bending accident

  • Tumors

  • Inflammation

  • Infections

  • Erectile dysfunction

  • Impotence

  • Priapism

  • Postoperative penis

  • Idiopathic

Penile Trauma

Penile fracture is usually caused by the exertion of axial forces on the erect penis, causing a tear of the tunica albuginea, resulting in subcutaneous extrusion of blood. This injury usually occurs during vigorous sexual intercourse. Self-inflicted injury by forceful downward bending of the erect penis to achieve detumescence, direct blunt trauma to the erect penis, and bite injuries are other causes of penile injury.

Blunt trauma to the flaccid penis usually does not cause penile fracture but may cause an extratunical or cavernosal hematoma. Intracavernosal hematomas also may occur in long-distance cyclists.

Penile Malignancy

The irritative effect of smegma in uncircumcised men is presumed to be an important cause of penile squamous cell carcinoma (SCC). Human papillomavirus types 16 and 18 are also reported in association with penile SCC. Chronic inflammation or urethral stricture may result in anterior urethral carcinoma.

Benign Palpable Masses

Cowper's duct syringocele results from the cystic dilatation of the main duct of the bulbourethral gland of Cowper. Penile hemangiomas and penile root neurofibromas are the other benign neoplasms of the penis.

Peyronie's Disease

The cause of Peyronie's disease is unknown and possibly multifactorial. The disease results in chronic inflammation, which leads to fibrosis and focal thickening of the tunica albuginea.

Erectile Dysfunction

Impotence is discussed in Chapter 75 .

Priapism

Priapism can be divided into low-flow and high-flow subtypes. Venous, low-flow, ischemic priapism is due to vascular stasis and decreased penile venous outflow. Causes include sickle cell disease or trait, other blood dyscrasias, neurologic abnormalities such as syphilis, brain tumors, brain and spinal cord injury, trauma, medication for erectile dysfunction (particularly if administered intracavernosally), other drugs such as antidepressants, and illicit drugs (particularly cocaine). Arterial, high-flow, nonischemic priapism is caused by perineal or penile blunt trauma with direct cavernosal artery injury and resultant formation of an arterial-lacunar fistula. It also may be caused by intracavernosal injections.

Prevalence and Epidemiology

Penile trauma is fairly uncommon but important because of its relative urologic emergency. Penile fracture is defined as rupture of a corpus cavernosum and its surrounding fibroelastic sheath, the tunica albuginea. Typically, a tear occurs in only one of the corpora cavernosa and its surrounding tunica albuginea; however, corpus spongiosum and urethral involvement may occur in approximately 20% of penile fractures.

SCC is the most common penile malignancy. It usually arises in the glans but also may arise in the urethra. Other urethral malignancies include transitional cell carcinoma and adenocarcinoma. Penile sarcomas are uncommon. Penile SCC is one of the most commonly seen malignancies in Asia and Africa but is rare in the United States, where African-American men are affected twice as often as white men. In children, rhabdomyosarcoma is the most common malignant tumor of the lower genitourinary tract, including the penis.

Peyronie's disease is uncommon, accounting for 0.3% to 0.7% of all urologic disorders. It occurs most often in the fourth to sixth decades of life and occasionally in men younger than 20 years of age.

Impotence is common and is discussed in Chapter 75 . Priapism can be arterial/high flow (nonischemic) or venous/low flow (ischemic). Low-flow priapism is a urologic emergency.

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts