NAME: S. A.
AGE: 33Yrs SEX: Male
Swollen penis – 4hrs
HISTORY OF PRESENTING COMPLAINT: Patient felt a sharp pain when he hit his erect penis against the inner thigh of his partner during sexual intercourse with his wife. This led to immediate detumescence . He therefore reported to the District Hospital – Sogakope for management of his condition. Patient initially did not disclose the history of painful swollen penis and had only complained of premature ejaculation, until he was triaged and found to have the swollen penis on examination.
ON DIRECT QUESTIONING: Intercourse not forceful, did not hit any pelvic bone with the penis, urinated normally post trauma, no hematuria, no fever,
PAST MEDICAL HISTORY- no documented medical condition but complains of premature ejaculation for which he had not sought any medical intervention.
SOCIAL HISTORY: Patient is married with 4 children and lives at Sogakope with his Family. He is a photographer by profession. He does not Smoke nor take alcohol. Patient does not have any health insurance package.
EXAMINATION: A young man, not acutely ill looking, not pale, not jaundiced, afebrile (36.5oC), hydration satisfactory
Status localis: swollen tender flaccid penis , o blood at the external urethral meatus. Scrotum and testis felt normal
Cardiovascular: PR – 70bpm BP – 123/79mmHg Heart Sounds I&II heard and normal. No murmurs heard
Chest: Clinically clear
Abdomen: Full, MWR, soft, non tender, no masses noted
Central Nervous System: Grossly intact
Diagnosis : Penile fracture
Condition explained to patient and consent sought for penile exporation to which he agreed after initial hesitation
lower abdomen , perineum , mid thigh cleaned with antispetic solution and draped routinely. Penile block executed with 10mls of 1% plain xylocain. Penis completely degloved with a circumcising incision. The haematoma identified below the Bucks fascia ,left midshaft of the penis . Fascia incised and haematwoma completely evacuated . The defect in the tunica repaired with nylon 5/0 .
IMMEDIATE POST OP MANAGEMENT
- IV morphine 10mg tds for 24hrs
- Oral paracetamol 1g tds for 24hrs
- IV clindamycin 300mg tds x 24hrs
- IV Amoksiklav 1.2g tds for 24hrs
Patient was discharged home on oral equivalent of medication .
Dr Richard Ametih
Urology resident, KATH