Hirurško ili konzervativno lečenje frakture penisa. (Serbian)

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  • Additional Information
    • Publication Year:
      2008
    • Author-Supplied Keywords:
      corpus cavernosum
      fracture
      penile
      fraktura
      korpus kavernosum
      penis
      EnglishCroatianLanguage of Keywords: English; Croatian
    • Abstract:
      Introduction: Penile fracture presents with rupture of corpora cavernosa. It is not rare but is remarkable. Treatment options are controversial I. Aim; To establish the incidence, what are early and late complications in patients treated surgically or with conservative treatment options (prospective/retrospective and randomized analysis). To find out what therapy verified as superior. Material and method: The total of 32 patients with typical acute penile fracture were analyzed. The patients were between 20 and 56 years of age (Mean age 40±7.25 SD). A total of 11 patients that presented up to 48h after the rupture of tunica albuginea (34.37%) were operated, while 9 patients (28.13%) were conservatively treated. 12 patients (37.5%) reported to andrology consulting room due to penile fibrous alterations and/or erectile dysfunction 6 to 14 months after the anamnesticaly established, typical penile fracture ("primary latent penile fracture"). Both groups of patients were strictly clinically followed 3, 6, 9 and 12 months after the penile fracture. Eventual development of late complications (erectile dysfunction ED, penile curvature, induratio, caverno-urethral fistula and urethral stenosis) was also recorded. Etiology of ED was investigated: anamnesticaly, by hormone and laboratory analysis, using penodynamic test (PGE1), Duplex Doppler echosonography. and dynamic cavernosography. Results: In the operated group of patients, (11 pts, 34.17%) preserved erectile capacity was recorded and no penile deformity or plaque lesions on the site of suture, after the patients were recommended to have 4 weeks of sexual abstinence. The rupture of tunica albuginea was always transversal in relation to penile axis i.e. in relation to axial force against which the penis acts during the intercourse. The rupture is always on the basis or mid penile portion . Out of 21 (65.63%) conservatively treated patients in 13 (61.9%) plaque lesions (longitudinal diameter 2 cm) was recorded, while sexual dysfunction was established in 13 patients (12 with ED and I patient with incapability for vaginal penetration). Evaluation of post therapeutical complications in relation to type of treatment, significantly higher frequency was recorded in the group of conservatively treated patients (p<0.01). Penile veno-oclusive dysfunction was registrated as significantly most frequent cause of ED (in 10 -- 76.92% out of 13 patients). All patients with ED had palpable fibrous lesion similar to Peyrone's plaque, while the degree of pcnik1 deviation correlated to the size of plaque lesion. Conclusion: The late complications of penile fracture were significantly more frequently recorded in the group of conservative treated patients (p<0.01) which proves that this lesion presents as urgent urological entity. The penile rupture is always transversal, and most probable place of rupture is physiological penile curve since this is the site of weakened structural integrity. [ABSTRACT FROM AUTHOR]
    • Abstract:
      Uvod: Fraktura penisa podrazumeva rupturu korpus kavernosuma crektilnog penisa. Penisna fraktura je neobična, ali nije retka. Oprečna su mišljenja o terapiji ovih bolesnika. Cilj: Utvrditi incidencu i vrstu ranih i kasnih komplikacija kod bolesnika sa frakturom penisa koji su lečeni konzervativno ili hirurški (prospektivnom/retrospektivnom i randomiziranom analizom). Utvrditi koja vrsta terapije je superiornija? Materijal i metod: Ukupno je ispitano 32 bolesnika sa klasičnom akutnom frakturom penisa. Bolesnici su imali od 20 do 56 godina (prosečna starost 40±7,25 godina, standardna devijacija). Operisano je 11(34,37%) bolesnika koji su se javili na pregled do 48h nakon tunikalnc rupture penisa. 9 (28,13%) bolesnika su konzervativno tretirana. 12 (37,5%)bolesnika se javilo na pregled u andrološku ambulantu zbog fibroznih promena na penisu ili erektilne disfunkcije 6-14 meseci nakon tipične anamneze klasične klinič slike fraktura penisa ("primarno latente frakture penisa"). Operativno i konzervativno lečeni bolesnici su striktno kilinički praၽeni 3, 6, 9 i 12 meseci nakon povrede penisa, kao i eventualni razvoj kasnih komplikacija (erektilna disfunkcija (ED), penisna kurvatura, induraracija, kaverno-uretralna fistula i uretralna stenoza). Etiologija ED je ispitana anamnezom, labaratorijskim i hormonskim analizama, penodinamskim testom (PGE1), Duplex doppler chosonografijom i dinamskom kavernozografijom. Rezultati: Kod svih 11 (34,37%) operisanih bolesnika je registrovan očuvan erektilni kapacitet, bez prisustva penisnog deformiteta i plak lezije na mestu suture, nakon postoperativno predložene seksualne apstinencije u trajanju od 4 nedelje. Ruptura (rascep) na t, albugineji je uvek transverzalan u odnosu na uzdužnu osu penisa odnosno na aksijalnu silu protiv koje se penis suprostavlja z vreme seksualnog odnosa. Ruptura je uvek na bazi penisa, ili u srednjoj trećini penisa. Od 21 (65,63%) konzervativno lečena bolesnika, kod 13 (61,9%) bolesnika je registrovana plak lezija (longitudinalni dijametar >2sm) i seksualna disfunkeija (12 bolesnika sa ED i 1 bolesnik sa nemogućom vaginalnom penetracijom). Poredjenjem post-terapijskih komplikacija u odnosu na 3 grupe formirane po tipu terapije registrovana je signifikantno češća učestalost komplikacija kod konzervativno lečenih bolesnika (p>0,01). Veno-okluzivna disfunkcija penisa je registrovana signifikantno najčešče kao uzrok ED, kod 10 (76,92%) bolesnika od 13 konzervativno lečena bolesnika sa seksualnom disfunkcijom (p < 0,01). Kod svih bolesnika sa ED je registrovana palpatorna fibrozna lezija slična plak leziji kod Pejronijeve bolesti, a stepen penisne devijacije korelira sa veličinom plak lezije. Zaključci: Kasne komplikacije frakture penisa su signifikantno češća registrovane u grupi bolesnika koji su konzervativno leč (p <0,01) u odnosu na grupu operisanih bolesnika, ukazuje da fraktura penisa treba i mora da predstavlja uro-hiruršku urgenciju. Ruptura penisa je uvek transverzalna, a verovatno predilekciono mesto rupture je fiziološka krivina penisa, jer je tu oslabljen strukturni integritet penisa. [ABSTRACT FROM AUTHOR]
    • Abstract:
      Copyright of Acta Chirurgica Iugoslavica is the property of Association of Yugoslav Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
    • ISSN:
      0354950X
    • Accession Number:
      41570037
  • Citations
    • ABNT:
      NALE, D. et al. Hirurško ili konzervativno lečenje frakture penisa. (Serbian). Acta Chirurgica Iugoslavica, [s. l.], v. 55, n. 1, p. 107–114, 2008. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edo&AN=41570037. Acesso em: 6 ago. 2020.
    • AMA:
      Nale D, Nikić P, Vuković I, Djordjević D, Vuksanović A. Hirurško ili konzervativno lečenje frakture penisa. (Serbian). Acta Chirurgica Iugoslavica. 2008;55(1):107-114. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edo&AN=41570037. Accessed August 6, 2020.
    • AMA11:
      Nale D, Nikić P, Vuković I, Djordjević D, Vuksanović A. Hirurško ili konzervativno lečenje frakture penisa. (Serbian). Acta Chirurgica Iugoslavica. 2008;55(1):107-114. Accessed August 6, 2020. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edo&AN=41570037
    • APA:
      Nale, D., Nikić, P., Vuković, I., Djordjević, D., & Vuksanović, A. (2008). Hirurško ili konzervativno lečenje frakture penisa. (Serbian). Acta Chirurgica Iugoslavica, 55(1), 107–114.
    • Chicago/Turabian: Author-Date:
      Nale, Dj., P. Nikić, I. Vuković, D. Djordjević, and A. Vuksanović. 2008. “Hirurško Ili Konzervativno Lečenje Frakture Penisa. (Serbian).” Acta Chirurgica Iugoslavica 55 (1): 107–14. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edo&AN=41570037.
    • Harvard:
      Nale, D. et al. (2008) ‘Hirurško ili konzervativno lečenje frakture penisa. (Serbian)’, Acta Chirurgica Iugoslavica, 55(1), pp. 107–114. Available at: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edo&AN=41570037 (Accessed: 6 August 2020).
    • Harvard: Australian:
      Nale, D, Nikić, P, Vuković, I, Djordjević, D & Vuksanović, A 2008, ‘Hirurško ili konzervativno lečenje frakture penisa. (Serbian)’, Acta Chirurgica Iugoslavica, vol. 55, no. 1, pp. 107–114, viewed 6 August 2020, .
    • MLA:
      Nale, Dj., et al. “Hirurško Ili Konzervativno Lečenje Frakture Penisa. (Serbian).” Acta Chirurgica Iugoslavica, vol. 55, no. 1, Mar. 2008, pp. 107–114. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edo&AN=41570037.
    • Chicago/Turabian: Humanities:
      Nale, Dj., P. Nikić, I. Vuković, D. Djordjević, and A. Vuksanović. “Hirurško Ili Konzervativno Lečenje Frakture Penisa. (Serbian).” Acta Chirurgica Iugoslavica 55, no. 1 (March 2008): 107–14. http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edo&AN=41570037.
    • Vancouver/ICMJE:
      Nale D, Nikić P, Vuković I, Djordjević D, Vuksanović A. Hirurško ili konzervativno lečenje frakture penisa. (Serbian). Acta Chirurgica Iugoslavica [Internet]. 2008 Mar [cited 2020 Aug 6];55(1):107–14. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&scope=site&db=edo&AN=41570037