Penile Fracture, Unusual Mechanism of Injury: A Case Report

Abstract

Background: Penile fracture is a rare but serious urological emergency involving rupture of the tunica albuginea of the corpus cavernosum, typically during vigorous sexual activity.  A sudden cracking sound, immediate pain, detumescence, and penile deformity often accompany it.  Prompt diagnosis and surgical repair are critical to prevent long-term complications.  This report presents a unique mechanism of penile injury causing fracture in a rural Ghanaian setting.  Case Presentation: A 26-year-old male presented three weeks after sustaining penile trauma while watching pornography in a supine position on a motorbike.  Physical examination revealed a swollen, ecchymosis, deformed penis (the classic "eggplant" sign).  Surgical exploration revealed a bilateral partial rupture of the corpora cavernosa and a complete 4x3 cm urethral tear.  The injury was repaired.  Despite the delayed presentation, the patient recovered uneventfully and regained normal erectile function within two weeks postoperatively. Discussion: This case underscores the challenges of managing penile fractures in resource-limited settings, including delayed presentation due to stigma and lack of local surgical expertise. While early intervention is preferred, successful outcomes are still achievable with delayed surgical management.  The ventral location of the injury correlated with the urethral involvement, consistent with anatomical susceptibility during erection.  Surgical approach via subcoronal degloving provided adequate exposure for complete repair.  Conclusion: Penile fracture with urethral involvement, even when presented late, can be effectively managed with surgical intervention in rural healthcare settings.  Clinicians should maintain a high index of suspicion and prioritise early diagnosis and surgical repair to optimise outcomes.