Fracture of corpora cavernosa with massive cavernosal-venous shunts.

A 43 year old white male with no significant past medical history presented to our emergency department (ED) with worsening penile pain and difficulty urinating. Several hours prior to admission, the patient was involved in a motor vehicle accident in which he was an unrestrained driver. His pelvis struck the steering wheel, while he was sexually aroused. Over the next 16 hours, his penis became increasingly swollen and painful. He presented to our ED when he was unable to void. On physical exam, the patient’s vitals were unremarkable. His chest was clear and abdomen was soft. The patient’s right thigh was discolored and swollen. His penis was enlarged and swollen with a very prominent and distended dorsal penile vein. Auscultation over the penis revealed a loud bruit. Urinalysis was positive for 20-30 red blood cells and isolated small blood clots. A retrograde urethrogram was attempted, revealing a concentrically compressed, pendulous urethra with incomplete filling of the bulbous urethra. There was no evidence of extravasation. However, the procedure was aborted secondary to intolerable pain. A T2-weighted MRI revealed a transverse fracture across the corpora cavernosa (Figure-1, black arrows). Minimal extravasation of blood was noted on the right juxta-corporal area extending through the tunica albuginea, but contained within Buck’s fascia (Figure-1, white arrow). A massively dilated draining vein was identified, indicative of arteriovenous shunt (Figure-2, arrow). Surgical exploration revealed two small arteriovenous fistulas, which were ligated without difficulty. The enveloping tunica was repaired and the patient recovered. He sustained no loss of erectile function.