A 37 year old man presented with a sudden cracking sound and acute pain during sexual intercourse followed by rapid detumescence, penile swelling and discoloration. Pain was aggravated by trying to urinate, but he could not pass the urine. Six hours after the penile trauma the patient was admitted to the emergency department.

Physical examination revealed a swollen, ecchymotic penis, blood on the urethral meatus and palpably full bladder. A retrograde urethrogram showed complete disruption at the proximal third of the urethra. The patient underwent immediate surgical exploration and repair of the fracture.

Circumferential subcoronal degloving incision (circumcision – like) and hematoma evacuation presented a partial tear of the tunica albuginea of both corpus cavernosum and complete urethral disruption. After minimal debridement and mobilization of proximal and distal corpus spongiosum the urethra was spatulated (figure 1). 2/0 vicryl interrupted sutures were used to repair rupture of both corpus cavernosus. An 18-F Foley catheter was indwelled in the bladder (figure 2). The urethra was anastomosed in one layer, tension free with 5/0 PDS interrupted sutures (figure 3). Redundant foreskin was removed before reapproximation.

Figure 1 Complete urethral disruption with partial rupture of both corpus cavernosum. Full size image

Figure 2 Sutured both corpus cavernosum and indwelled Foley catheter. Full size image

Figure 3 T-T anastomosis of the urethra. Full size image

A broad spectrum antibiotic and low molecular heparin (dalteparin) were given during the hospital stay. Nocturnal erections recovered on the third postoperative day and they were mitigated with diazepam. On day 12 the catheter was removed and on day 13 the patient was released home. The antibiotic was continued at home for the next 10 days.

During the one year follow up period the patient presented with normal uroflowmetry one, six and twelve months after the surgery (max. flow rates were 22, 23 and 25 ml/s), with slight, stable and clinical insignificant urethral stricture on retrograde urethrogram 6 and 12 month after surgery and with normal voiding and sexual function.