A few days ago while sleeping a rolled over on my erection and heard a pop/crack. I thought I had fractured my penis. I did have an immediate loss of erection but no hematoma developed until later in the day. There was no pain when I heard the pop/crack. My penis was not sore or tender to the touch as I tried to feel for the break or clot at the possible fracture site, there was no swelling, there was no blood in my urine and my penis seemed to be straight with no curvature or kink. Later that evening there was an expanding hematoma developing. But still no pain, no swelling, no uncomfort, and no deformity, and I was also able to get a pretty strong erection. The hematoma was pretty much just contained to the shaft of my penis dorsally. The next day the hematome expanded ever so slightly to the superior portion of the left side of my scrotum. I was away from home when this happened and called my urologist the next day. He saw me on day three and examined me. Mind you I live in a large metropolitain city with some of the very best Urologists who have seen penile fractures before. I read a bunch of liturature and was extremely concerned with the complication rates. The surgeon examined me and upon physical examination found no blood in my urine as I suspected and by feel found that my tunica was intact. The only thing evident to him was the hematoma and maybe some very very mild swelling. He suggested I not use my penis for at least 2 weeks. I asked him if there was anyway to be certain there was not a fracture. He told me the only was was to do a penile exploration by degloving my penis. He assured me that from his physical exam there were more risks associated with the exploation then with the "fractured penis" I supposedly presented with. (To be honest the most pain I felt was him poking around hard deep at the base of my penis) I was not very comfortable with the answer. I asked if an MRI would rule out a tear. He said he thought it was not nessecary but would order one if I wanted. I asked to see a senior partner one of the most well respecteed Urologists in town practicing over 22 years. The senior partner agreed with his partner on all accounts except upon exam he said he said it may have not been a fracture? My question is what else could have caused the hematome and the pop or slight crack I think I heard?
Traumatic injury to the penis in a state of erection can cause the development of hematoma or arteriovenous fistula.
It is obvious that there was some amount of trauma to the penis and that it may have disrupted the continuity of the corpora of the penis even though it has not caused any tear or injury to the urethra, hence no blood in the urine.
In cases where there is formation of a fistula following injury, intervention should be undertaken within 6 hours for best results. Diagnosis is aided by a penile doppler ultrasound. Degloving is not required to estimate the extent of the injury as an ultrasound can pick up the size, extent, and type of injury and can be followed up with other radiological investigations, if required.
Do keep us posted on any further doubts in this regard.
Thanks for the response. I am happy to report after consultation with 2 very high profile Urologist in my hometown it seems as they may have been right with their diagnosis. My urologist asked a few probing questions upon physical exam to make their diagnosis. As I stated above I inquired above ultrasound and or MRI to help with the diagnosis. I was almost 100% sure it was a fracture and was upset that they saw it not needed (Ultrasound/dopplar/MRI) if anything to just ease my mind. They said they could have located the fracure if it was evident just by looking at, rolling, and feeling the shaft of my penis even though there was a fairly sizeable hematoma with some expansion to my scrotum. Since that time I have not used my penis for masterbation or intercourse on doctors orders. They wanted me to wait until the hematoma resolved. Interestingly enough other then the deep probing at the base of my penis/pelvis and the soreness that followed I really have not had any pain at all, not even when I thought I fractured it. I find it interesting that Urologists do not have a classification system for these types of injuries, and with that classification system there would be indication for surgery. I am pleased to anounce at this point that I have have very full erections with no deformity that I can really recognize. I wonder if there will be any scar tissue issues in the future from this injure which will make sex painful but at this point I am happy I did not ask for surgery as I fear they would have done some sort of penile exploration and and degloving which potentially could of had much more possibility of complications.
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