Abstract Introduction Penile fracture is a rare urological emergency, typically involving unilateral rupture of the tunica albuginea of the corpus cavernosum. Bilateral corporal rupture, especially when associated with concomitant urethral injury, is exceedingly uncommon. Prompt diagnosis and surgical repair are crucial to preserve erectile and urinary function. Objective To present a rare case of a penile fracture with triple rupture – affecting both corpora cavernosa and the urethra/corpus spongiosum – and to describe its management and outcome. Methods A 35 year-old male sustained blunt penile trauma during sexual intercourse, followed by a characteristic “cracking” sound, immediate penile pain with detumescence, moderate urethral bleeding and urinary retention. Physical examination revealed an eggplant penile deformity, mild dorsal curvature, and meatal blood. Penile ultrasound identified bilateral ventral rupture of the corpora cavernosa and dorsal disruption of the proximal penile urethra. Retrograde urethrography confirmed an anterior urethral injury and allowed dermographic marking at the leakage level. Surgical exploration, performed 9 hours post trauma via a midline penoscrotal incision, revealed triple rupture. Both corpora cavernosa were repaired, and a primary end-to-end urethroplasty was completed with absorbable sutures. Results In terms of functional outcomes, the patient experienced spontaneous morning erections in the early postoperative period. Postoperative complications were limited to superficial cutaneous blistering due to improper ice application. The catheter was removed on day 40 with normal voiding. At 6-month follow-up, no palpable nodules were detected, and the patient did not report penile curvature during erection. The International Prostate Symptom Score (IPSS) was 1 and the International Index of Erectile Function – 5 (IIEF-5) was 25. Uroflowmetry demonstrated a maximum flow rate (Qmax) of 26.6 mL/s with a total voided volume of 450 mL. Retrograde urethrography showed no anastomotic leakage or stricture. Conclusions This case illustrates a rare triple penile rupture and highlights the value of preoperative imaging in surgical planning. Knowing the precise location of corporal and urethral injuries allowed for a less invasive approach via a midline penoscrotal incision. The favorable outcome supports the role of early primary urethral reconstruction in complex penile fractures. Further studies are warranted to standardize management and long-term follow-up in such cases. Disclosure No
Marques et al. (Mon,) studied this question.