International Journal of Urology (2004) 11, 811–812 Blackwell Science, LtdOxford, UKIJUInternational Journal of Urology0919-81722004 Blackwell Publishing Asia Pty LtdSeptember 2004119811812Case Report Disruption of corpus cavernosum with urethral ruptureA Soylu et al. Correspondence: Ahmet Soylu MD, Department of Urology, Inonu University Medical Faculty, Malatya 44069, Turkey. Email: asoylu@inonu.edu.tr Received 4 November 2003; accepted 20 January 2004. Case Report Bilateral disruption of corpus cavernosum with complete urethral rupture AHMET SOYLU, UGUR YILMAZ, MURSEL DAVARCI AND CAN BAYDINC Department of Urology, Inonu University Medical Faculty, Malatya, Turkey Abstract Penile fracture is a relatively rare condition. We report an unusual case of the bilateral disruption of the corpus cavernosum with complete urethral rupture resulting from blunt trauma during sexual intercourse. The subject underwent emergency surgery with preservation of erectile and voiding functions in the follow-up. Key words corpus cavernosum, fracture, penis, urethra, urethral trauma. Introduction Penile fracture is the rupture of the tunica albuginea of one or both corpus cavernosum due to direct trauma to the erect penis. It may be accompanied with partial or complete urethral rupture or with injury to the deep dorsal vein. 1,2 Rarely, penile fracture may to occur the non-erect penis. 3 We report the surgical repair of a penile fracture including bilateral disruption of corpus cavernosum with complete urethral rupture. Case report A 45-year-old man presented with inability to pass urine, acute penile pain, penile swelling and rapid detu- mescence following a blunt trauma against his partner’s perineum during sexual intercourse 10 hours before his admission to the emergency department. On physical examination, there was swelling and subcutaneous hematoma in the penis, scrotum and mons pubis with a left-sided deviation of the penis (Fig. 1). He had bloody urethral discharge. The bladder was distended. Retro- grade urethrography showed complete urethral rupture. He underwent emergency surgery. A penile subcoronal circumcising incision was made and the hematoma was evacuated. There were two 1.5-cm and 2.5-cm trans- verse tears in the left and right tunica albuginea, respec- tively, and complete urethral disruption (Fig. 2). A 16 F urethral catheter was passed into the bladder. Defects of both corpora was repaired by interrupted 2/0 vicryl sutures and the urethra was anastomosed end-to-end with 4/0 vicryl sutures in a tension-free manner. Hematoma and urine were evacuated from the scrotum with a 2-cm longitudinal scrotal incision. He had an uneventful recovery. Urethral catheter was removed at postoperative 21st day. Three months later, the patient was evaluated by uro- flowmeter and penile color Doppler ultrasonography. He had normal erectile and voiding functions. The post- operative results of uroflowmetry were normal with average and maximal flow rates of 22 and 39 mL/s, respectively. Penile color Doppler ultrasonography showed no arterial or venous insufficiency with normal erection after an 60 mg intracorporeal papaverin injection. Discussion The tunica albuginea is one of the strongest fascias in the human body. It is 2 mm thick in the flaccid state, but during erection, the tunica is reduced to only 0.25–0.50 mm. Thus, it is the thinner tunica which makes the erect penis weak to traumatic injury. 4 De Rose et al. found histopathological abnormalities such as perivascular lymphocyte infiltration and fibro- sclerosis in 83% of fractured corpora, which suggests the presence of predisposing factors for penile frac- ture. They also measured the elasticity of tunica albuginea and proposed an intracorporeal pressure of