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Penil fraktür: 11 yıllık deneyim
Soylu, A.; Güneş, A.; Uğraş, M. Y.; İpek, D.; Baydinç, C.
Date:
2003
Abstract:
Öz:Penil fraktür, ereksiyon halindeki penisin direkt travmaya maruz kalması sonucu tek veya iki taraflı korpus kavernozumda tunika albugineanın yırtılmasıdır. Penil fraktüre parsiyel veya komplet üretra rüptüru veya derin dorsal ven yaralanmaları da eşlik edebilir. Bu çalışmada kliniğimize 1992-2003 yılları arasında penil fraktür nedeniyle başvuran 15 olgudaki 11 yıllık klinik deneyimimiz sunulmaktadır. Olgularımızın 14'ü ilk 24 saatte başvurdu ve hepsine acil cerrahi girişim uygulandı. Bir olgu penil fraktürden 6 ay sonra başvurdu. Hastaların 9'unda sağ, 4'ünde sol, birinde her iki korpus kavernozumlarda tunika albuginealarda 1-2,5 cm arasında değişen uzunluklarda yırtılmalar vardı. Bilateral yırtılma olan hastada aynı zamanda komplet üretra rüptüru vardı. Bir olguda da sadece derin dorsal ven rüptüru meydana gelmişti. Postoperatif komplikasyon olarak 2 olguda ereksiyon kalitesinde azalma, 3 olguda ağrılı ereksiyon ve 2 olguda prematür ejakülasyon gelişti. Geç başvuran ve cerrahi onarım yapılmayan hastada ise penil bükülme ve ağrılı ereksiyon vardı. Penil fraktür olguları dünya geneline göre ülkemizde oldukça sık görülmekte olup sayı gittikçe artmaktadır. Tanı ve tedavisinin iyi bilinmesi önemlidir. Bizim 11 yıllık tecrübemize göre acil cerrahi girişim postoperatif komplikasyonları önlemede etkin tedavi yöntemidir.
Description:
Öz (İngilizce):Objectives: Penile fracture is the rupture of the tunica albuginea of one or both corpora cavernosa due to direct trauma to the erected penis. Partial or complete rupture of the urethra or injury to the deep dorsal vein may accompany to penile fracture. In this study, we present our clinical experience in 15 patients presented with penile fracture between 1992 and 2003. Material and Methods: Fourteen of the cases applied in the first 24 hours and all has undergone emergency surgery. One case applied six months after the fracture of his penis. Of the patients 9 had right, 4 had left and one had both cavernosal tunical ruptures, with defects of 1 to 2.5 cm in length. Patient with bilateral injury had accompanying complete urethral rupture. One patient had deep dorsal vein rupture. Defects of corpora cavernosa was repaired by interrupted 2/0 vicryl sutures. Tension-free end-to-end anostomosis with 4/0 vicryl sutures was performed for complete urethral rupture, after releasing both ends. Ruptured deep dorsal vein was ligated at both ends with 2/0 vicryl. Results: The patients were aged between 19 and 72 (mean: 36.2 years). Of the cases, 14 have applied within 2 to 13 hours from the rupture and one after 6 months. Seven (46.7%) of the fractures was due to penile straightening or bending by hand, 4 (26.7%) due to sexual intercourse, 2 (13.3%) due to turning on or falling from the bed, 1 (6.7%) due to a child fallen on to the penis while joking, and 1 (6.7%) due to slamming by door. The patient who applied 6 months after the fracture got the diagnosis of impulse control disorder with psychiatry consultation. As postoperative complications, two patients had decreased quality of erections; three had painful erections and two had premature ejaculation. Patient who has not undergone emergency surgical correction due to late application had painful erection with penile deviation. Conclusion: Urethral rupture is usually partial and only seldomly complete among the patients. Among the penile fracture cases from our country, 2.5% had accompanying incomplete urethral rupture. At first, conservative methods like cold applications, antiinflammatory drugs and suppression of erection have been preferred for penile fracture treatment. Recently, early surgical repair of corpora cavernosa that decreases complication rates are being applied. Cases of penile fracture are more common and are increasing in number in our country when compared to cases worldwide. It is important to have knowledge on diagnosis and treatment. According to our experience of 11 years, emergency surgery is the efficient method of treatment to prevent postoperative complications.
