Skip to main content

Traumatisme de la verge et des organes génitaux

Testicular and penile injuries

Résumé

Les traumatismes testiculaires sont le plus souvent des traumatismes fermés rencontrés lors d’accidents de la voie publique ou de sport. Un gros testicule douloureux dans ce contexte fait poser le diagnostic et l’échographie oriente la thérapeutique vers la chirurgie en cas de rupture de l’albuginée ou de gros hématome intra testiculaire. Deux patients sur trois seront opérés et les principales séquelles rencontrées en cas de diagnostic et traitements tardifs sont l’atrophie testiculaire, la stérilité voire l’impuissance.

Les fractures du pénis sont secondaires à un traumatisme direct sur le pénis en érection avec rupture de l’albuginée et entraînent hématome, douleur et déviation pénienne. Une plaie urétrale doit être systématiquement recherchée. Cavernographie, échographie ou IRM peuvent aider au diagnostic sans être systématiques. Le traitement de référence est chirurgical précoce et les complications possibles sont les déviations péniennes, douleurs, dysfonction érectile.

Abstract

The most frequent cause of testicular injuries is blunt trauma (following sports injuries or road accidents). Penetrating injuries are rare. Increased scrotal volume and a painful testis are the main symptoms and require scrotal ultrasonography. Scrotal ultrasonography is very sensitive and specific for testicular rupture or intratesticular haematoma. Two out of three patients with testicular injuries require surgical exploration. Secondary complications due to delayed management of trauma are testicular atrophy, sterility or impotence.

Penile fracture (rupture of corpus cavernosum) is due to direct trauma by an excessive force applied to an erect penis. Swelling, penile ecchymosis, penile curvature and pain are the usual symptoms of rupture of the tunica albuginea. Urethral injury must be ruled out. Cavernosography, ultrasonography or MRI are not considered mandatory to establish a diagnosis but can be prescribed in the absence of typical signs or symptoms. Early surgical exploration and repair ensure a better outcome. Secondary complications are penile curvature, chronic pain and impotence.

References

  1. 1.

    AL SALEH B.M., ANSARI E.R., AL ALI I.H. et al.: Fractures of the penis seen in Abu Dhabi. J. Urol., 1985, 134: 274–275.

    PubMed  Google Scholar 

  2. 2.

    ASGARI M.A., HOSSEINI S.Y., SAFARINEJAD M.R. et al: Penile fractures: evaluation, therapeutic approaches and long-term results. J. Urol., 1996, 155: 148–149.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    BENCHEKROUN A., IKEN A., KASMAOUI E. et al.: Traumatisme des bourses. A propos de 40 cas. Ann. Urol., 2001, 35: 349–352.

    Article  CAS  Google Scholar 

  4. 4.

    BERGNER D.M., WILCOX M.E., FRENTZ G.D.: Fracture of penis. Urology, 1982, 20: 278–280.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    BUCKLEY J.C., McANINCH J.W.: Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J. Urol., 2006, 175: 175–178.

    PubMed  Article  Google Scholar 

  6. 6.

    CASS A.S., LUXENBERG M.: Testicular injuries. Urology, 1991, 37: 528–553.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    CASS J.: Immediate radiological evaluation and early surgical management of genito-urinary lesions from external trauma. J. Urol., 1979, 122: 722–724.

    Google Scholar 

  8. 8.

    CENDRON M., WHITMORE K.E., CARPINIELLO V. et al.: Traumatic rupture of the corpus cavernosum: evaluation and management. J. Urol., 1990, 144: 987–991.

    PubMed  CAS  Google Scholar 

  9. 9.

    CROSS J.J.L., BERMAN L.H., ELLIOTT P.G. et al.: Scrotal trauma: a cause of testicular atrophie. Clin. Radiol., 1999, 54: 317–320.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    DE ROSE A.F., GIGLIO M., CARMIGNANI G.: Traumatic rupture of the corpora cavernosa: new physiopathologic acquisitions. Urology, 2001, 57: 319–322.

    PubMed  Article  Google Scholar 

  11. 11.

    DESCOTES J.L., HUBERT J.: Apport de l’imagerie dans les traumatismes de la verge. Prog. Urol., 2003, 13: 1157–1160.

    PubMed  CAS  Google Scholar 

  12. 12.

    DINCEL C., CASKURLU T., RESIM S. et al.: Fracture of the penis. Int. Urol. Nephrol., 1998, 30: 761–765.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    EKE N.: Fracture of the penis. Br. J. Surg., 2002, 89: 555–565.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    ELABD S., ABU FARHA O., EL GHARBAWI M. et al.: Fracture of the penis and the result of surgical management. Injury, 1988, 19: 381–383.

    Article  CAS  Google Scholar 

  15. 15.

    EL SHERIF A.E., DAULEH M., ALLOWNEH N. et al.: Management of fracture of the penis in Qatar. Br. J. Urol., 1991, 68: 622–625.

    PubMed  Article  Google Scholar 

  16. 16.

    FERGANY A.F., ANGERMEIER K.W., MONTAGUE D.K.: Review of Cleveland Clinic experience with penile fracture. Urology, 1999, 54: 352–355.

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    FERREIRA V., RIVERO M.A., SHIRREN C. et al.: Male fertility after unilateral orchiectomy comparative study. J. Urol., 1989, 141: 441A.

    Google Scholar 

  18. 18.

    GOMES C.M., RIBEIRO-FILHO L., GIRON A.M. et al.: Genital trauma due to animal bites. J. Urol., 2000, 165: 80–83.

    PubMed  Article  Google Scholar 

  19. 19.

    GROSS M.: Rupture of the testicle, the importance of early surgical treatment. J. Urol., 1969, 101: 196–197.

    PubMed  CAS  Google Scholar 

  20. 20.

    HINEV A.: Fracture of the penis: treatment and complications. Acta Med. Okayama, 2000, 54: 211–216.

    PubMed  CAS  Google Scholar 

  21. 21.

    KARADENIZ T., TOPSAKAL M., ARIMAN A. et al.: Penile fracture: differential diagnosis, management and outcome. Br. J. Urol., 1996, 77: 279–281.

    PubMed  CAS  Google Scholar 

  22. 22.

    KATTAN S., YOUSSEF A., ONUARA V., PATIL M.: Recurrent ipsilateral fracture of the penis. Injury, 1993, 24: 685–686.

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    MANSI M.K., EMRAN M., EL MAHROUKY A. et al.: Experience with penile fractures in Egypt: long-term results of immediate surgical repair. J. Trauma., 1993, 35: 67–70.

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    MBONU O.O., AGHAJI A.E.: Fracture of the penis in Enugu, Nigeria. J.R. Coll. Surg. Edinb., 1992, 37: 309–310.

    PubMed  CAS  Google Scholar 

  25. 25.

    MICALLEF M., AHMAD I., RAMESH N. et al.: Ultrasound features of blunt testicular injury. Injury, 2001, 32: 23–26.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    MUNTER T.W., FALESKI E.J.: Blunt scrotal trauma, emergency department evaluation and management. Am. J. Emerg. Med., 1989, 7: 227–232.

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    NICOLAISEN G., MELAMUD A., WILLIAMS R.D. et al.: Rupture of the corpus cavernosum: surgical management. J. Urol., 1983, 130: 917–919.

    PubMed  CAS  Google Scholar 

  28. 28.

    NOURI M., KOUTANI A., TAZI K. et al.: Les fractures du pénis: à propos de 56 cas. Prog. Urol., 1998, 8: 542–547.

    PubMed  CAS  Google Scholar 

  29. 29.

    ORVIS B.R., MC ANINCK J.W.: Penile rupture. Urol. Clin. North Am., 1989, 16: 369–375.

    PubMed  CAS  Google Scholar 

  30. 30.

    PAPAREL P., N’DIAYE A., LAUMON B. et al.: The epidemiology of trauma of the genitourinary system after traffic accidents: analysis of a register of over 43 000 victims. Br. J. Urol. Int., 2006, 97: 338–341.

    Google Scholar 

  31. 31.

    PHILP T., COLLIN J.: The fractured shaft — an unusual penile injury. Br. J. Surg., 1983, 70: 93.

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    PRUNET D., BOUCHOT O.: Les traumatismes du pénis. Prog. Urol., 1996, 6: 987–993.

    PubMed  CAS  Google Scholar 

  33. 33.

    RUCKLE H.C., HADLEY H.R., LUI P.D.: Fracture of penis: diagnosis and management. Urology, 1992, 40: 33–35.

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    SLAVIS S.A., SCHOLZ J.N., HEWITT C.W. et al.: The effects of testicular trauma on fertility in the lewis rat and comparisons to isoimmunized recipients of syngeneic sperm. J. Urol., 1990, 143: 638–641.

    PubMed  CAS  Google Scholar 

  35. 35.

    UYGUR M.C., GULERKAYA B., ALTUG U. et al.: 13 years’ experience of penile fracture. Scand. J. Urol. Nephrol., 1997, 31: 265–266.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    WESPES E., LIBERT M., SIMON J. et al.: Fracture of the penis: conservative versus surgical treatment. Eur. Urol., 1987, 13: 166–168.

    PubMed  CAS  Google Scholar 

  37. 37.

    ZARGOOSHI J.: Penile fracture in Kermanshah, Iran: report of 172 cases. J. Urol., 2000, 164: 364–366.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Olivier Simonin.

Additional information

Présentation au XXIIème congrès de la SALF Marseille 2005

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Simonin, O., Carcenac, A., Delapparent, T. et al. Traumatisme de la verge et des organes génitaux. Androl. 16, 187–196 (2006). https://doi.org/10.1007/BF03034858

Download citation

Mots clés

  • traumatisme organes génitaux externes
  • traumatisme testiculaire
  • fracture pénis
  • hématome testicule
  • atrophie testiculaire
  • impuissance

Key words

  • trauma
  • external genital organs
  • testicular trauma
  • pertile fracture
  • testicular haematoma
  • testicular atrophy
  • impotence