Penile structural abnormalities and acute injuries: Diagnosis and treatment of induration, fracture, and curvature

Peyronie's disease, also known as penile fibrosis, is most common in middle-aged men around 40 years old. The causes may be related to vitamin E deficiency, mild inflammation, sclerosing inflammation, and degenerative changes. The onset is slow, often sudden, or only noticed when there is pain in the penis during intercourse. Because the lesion mainly occurs as a fibrous change between the tunica albuginea and the deep fascia of the penis, affecting the corpora cavernosa and its stroma, but generally not involving the urethra or adhering to the skin, it is primarily characterized by fibrosis and hardening, eventually leading to local calcification or ossification. Therefore, the clinical manifestations are mainly single or multiple oval plaques or cord-like indurations found on the corpora cavernosa and dorsal surface of the penis, arranged in rows, resembling cartilage, and hardening over time. The indurations are not adherent to the skin. Occasionally, there may be perineal discomfort, a feeling of heaviness, or mild stinging and difficulty urinating. In severe cases, it can cause sexual dysfunction, leading to weak or painful erections, penile curvature, and ultimately impotence and premature ejaculation. The differential diagnosis of Peyronie's disease from penile cancer, foreskin stones, penile sclerosing lymphangitis, penile tuberculosis, etc. is as follows:

① Penile cancer. A hard lump appears in the coronal sulcus, accompanied by burning and itching. It progressively enlarges, and after ulceration, it resembles cauliflower and has a foul odor. ② Foreskin stones. Commonly seen in men with phimosis or paraphimosis, these are formed by the deposition of smegma and urate crystals, adhering to the coronal sulcus. They can be removed by retracting the foreskin, soaking in water, and gently wiping. ③ Sclerosing lymphangitis of the penis. Caused by the proliferation of fibrous tissue in the lymphatic vessels, it manifests as curved, cord-like structures on the dorsal side of the penis and coronal sulcus, not attached to the skin. Aside from mild pain, there are no other discomforts, and most cases heal spontaneously. ④ Penile tuberculosis. Small tuberculous nodules occur in the glans penis, frenulum, and corpora cavernosa. They appear as small, red, raised bumps, painless or with only mild pain. The surrounding area swells and hardens, forming scabs. After the scabs fall off, a persistent ulcer forms. If it invades the urethra, a burning sensation will occur, along with painful urination and urinary frequency. Tuberculosis bacilli can be detected in the discharge.

The main treatment methods for Peyronie's disease are: ① Vitamin E 100 mg, three times daily, for 3-6 months. ② Local injection. Inject 0.5-1 ml of sterile suspension of triamcinolone acetonide A with 1 ml of 0.5% lidocaine locally once a week. In the early stages of treatment, infiltration injections can only be made around the induration. After the induration softens, it can be injected directly into the induration. When the induration is large or has invaded both sides of the corpora cavernosa, multiple injections can be used. After injection, apply pressure to the local area for 1-2 minutes. After 6 injections, wait 2 weeks between injections. Alternatively, 25 mg of prednisolone acetate plus 1 ml of 2% procaine can be used for local injection, twice a week, for 20 injections as one course of treatment. During injection, the medication should not be injected into a blood vessel. Physiotherapy such as "audio-frequency" can be used to enhance the effect. ③ Traditional Chinese medicine preparations such as Dinggui San or Qili San can be applied to the affected area, along with treatment based on syndrome differentiation. Drug treatment should be carried out under the guidance of a specialist doctor. Most symptoms can be relieved after conventional treatment, but 10% of patients have poor results and require surgical removal of the induration and correction of penile curvature. For those with pathological erectile dysfunction or those for whom other surgical treatments are ineffective, penile prosthesis implantation can be used. ④ Ultrasound or infrared therapy.

Penile fracture, also known as penile rupture or penile injury, usually refers to the tearing of the tunica albuginea of ​​the corpora cavernosa during penile erection due to blunt force trauma. It is commonly referred to as a penile "fracture." There are many ways it can occur, such as excessive movement by the male partner during intercourse, excessive twisting by the female partner, turning over during erection, or external impact to the erect penis. In fact, from a medical perspective, the penis does not have bones; "penile fracture" is simply a figurative way of describing a penile breakage. Anatomically, the penis is composed of two corpora cavernosa and one corpus spongiosum, arranged in an inverted "品" shape. The urethra passes through the corpus spongiosum, connecting internally to the bladder and externally to the glans penis. The corpora cavernosa contain abundant vascular sinuses, all surrounded by a tough tunica albuginea to form a single unit. During erection, the vascular sinuses within the corpora cavernosa become congested with blood, with blood flow reaching 80-120 ml per minute, 25 times greater than in the flaccid state. Because the corpora cavernosa are filled with blood, the tunica albuginea of ​​the penis is in a state of high tension. If subjected to strong external force, the tunica albuginea can rupture, producing a crisp "pop" sound accompanied by severe pain. The penis immediately becomes flaccid, and the skin swells due to hematoma, turning bluish-purple. The penis then deviates to the opposite side of the injury; this is medically known as penile fracture. If penile fascia injury occurs, blood can seep into the scrotum or perineal skin along the fascial spaces. If urethral injury is also present, urethral bleeding or hematuria may occur. Those without urethral injury generally urinate normally, but occasionally experience difficulty urinating due to hematoma compression. The rupture usually occurs below the hematoma. Injuries can occur at any part of the penis, but are most common in the proximal third.

Analysis of data suggests that penile fractures often occur on the wedding night of the groom, as well as among those engaging in extramarital affairs. This is often due to excessive excitement and tension, excessive force during intercourse, or incorrect movements that cause the erect penis to strike other areas instead of the vaginal opening. Additionally, improper sexual positions or attempts at manipulation can lead to a sudden, forceful bend during erection. Secondly, significant impact or pressure during erection can also easily cause fracture. Furthermore, improper masturbation practices, such as striking or forcefully bending the erect penis, or repeatedly inserting it into an object for sexual release, can also easily result in penile fracture.

What should you do if your penis is fractured? First, remain calm and don't panic. Immediately stop sexual intercourse to prevent further erection, which could worsen the condition. Then, seek medical attention as soon as possible. Don't be ashamed to talk about it or avoid seeking medical help. Do not attempt to treat it yourself or consult a quack doctor. Generally, for minor ruptures with minimal bleeding, conservative treatment is possible, including: ① External application: Apply cold compresses initially, then switch to warm compresses once bleeding stops to promote absorption of the blood clot and reduce swelling. ② Drug therapy: Use herbs such as Sanguisorba officinalis, Corydalis yanhusuo, Angelica dahurica, Salvia miltiorrhiza, Prunus persica, Lonicera japonica, Viola yedoensis, Curcuma longa, and Angelica sinensis tail to stop bleeding, relieve pain, and promote blood circulation. If the rupture is accompanied by significant bleeding, surgery may be necessary to eliminate the hematoma and repair the tunica albuginea of ​​the corpora cavernosa.

Some men's penises show no abnormalities when flaccid, but become curved during erection. Most men's penises curve to varying degrees in one direction, which generally does not affect sexual life and requires no treatment. However, some men's penises are curved vertically, unable to straighten after erection, resembling the front half of a faucet when viewed from the side. This can cause pain during intercourse, or even make intercourse impossible. The main causes of vertical curvature are as follows: ① Congenital short frenulum. ② Excessive foreskin removal during circumcision. ③ History of penile trauma or infection, resulting in local scarring. ④ Sequelae of sexually transmitted diseases (such as syphilis). ⑤ Peyronie's disease. ⑥ Congenital painful erection or a short suspensory ligament.

If penile curvature is not severe and does not significantly affect sexual life, treatment may not be necessary. Just be careful during intercourse and avoid overly vigorous movements to prevent impact, pain, or penile fracture. If penile curvature is severe and significantly impacts sexual life, prompt examination and treatment at a urology department are recommended. This issue can usually be resolved surgically. Especially for cases of painful erections or short suspensory ligaments, a thorough examination of the location of the suspensory ligaments, the degree of fibrosis or ossification of the tunica albuginea of ​​the corpora cavernosa, and any other possible abnormalities is necessary before targeted treatment can be administered to resolve the condition.