The injuries relevant for erectile dysfunction almost exclusively affect the penis. Blunt or penetrating testicular injuries rarely result in secondary atrophy with conservative or reconstructive-surgical therapy, which can then generally also show negative effects at most for the fertility prognosis. Penile rupture, also known as penile fracture, is the most important of all penile injuries in terms of influencing erectile function. It is a tear of the tunica albuginea with secondary hematoma formation outside the corpus cavernosum. This injury occurs due to kinking of the erect penis, usually during sexual intercourse. Other trauma, such as repositioning during sleep to the prone position, manual manipulations aimed at detumescence, and impact on hard objects have also been described . Anamnestically, patients report a cracking sound with a localized sting at the time of injury. In cases of significant hemorrhage into the subcutaneous tissue with diffuse swelling and hematoma discoloration of the entire penis (“penis Lumumba”), possibly combined with penile deviation and scrotal and perineal swelling (“saxophone phenomenon”), the patient generally seeks medical attention immediately. In these cases, which are urologic emergencies, early surgical treatment with hematoma evacuation and suturing of the tunica albuginea should be sought. Results are mostly excellent, with complete restitutio ad integrum. If the rupture is left untreated, a connective tissue-limited hemorrhage may develop over the defect in the tunica albuginea into the subcutis, which can be palpated clinically as a fluctuating mass and confirmed sonographically (Fig. 4.1).
Fig. 4.1. Sonographic image of an encapsulated hematoma subcutaneously (arrows) after penile rupture.
Fig. 4.2. Cavernosography in fresh penile fracture with extravasation in the anterior third of the penis – the soft tissue swelling of the anterior penis is clearly visible (saxophone phenomenon).
Anamnestically, patients report local swelling, possibly associated with limb deviation. This can also be remedied by secondary surgical therapy, whereby the leakage site can be localized by cavernosography (Fig. 4.2). However, if there is only minor hematoma formation without penile deviation and cavernosography no longer shows contrast leakage, a conservative treatment strategy is also warranted. Traumatic penile amputations as a result of accidents or self-mutilation can still be successfully managed under the surgical microscope if timely care is provided. Penile injuries following masturbatory practices with a vacuum cleaner also generally have no adverse consequences for erectile function after surgical treatment. Because all injuries to the penile area have the possibility of involvement of the urethral tubes, a careful local examination should always be performed. Leading symptoms of such an injury were bleeding from the urethral tube, hematuria, micturition pain, or urinary retention. If this is suspected, early urethrography followed by urinary diversion by suprapubic or transurethral catheter with contrast extravasation should be performed.