FRAKTURA PENISA UDRUŽENA SA POVREDOM URETRE – PRIKAZ SLUČAJA

Nebojša Prijović; Branko Stanković; Milan Radovanović; Veljko Šantrić; Uroš Babić

doi:10.5937/smclk7-64882

Nebojša Prijović Klinika za urologiju, Univerzitetski klinički centar Srbije https://orcid.org/0000-0002-5268-5801
Branko Stanković Klinika za urologiju, Univerzitetski klinički centar Srbije; Medicinski fakultet, Univerzitet u Beogradu https://orcid.org/0000-0002-8554-8344
Milan Radovanović Klinika za urologiju, Univerzitetski klinički centar Srbije; Medicinski fakultet, Univerzitet u Beogradu https://orcid.org/0000-0001-8835-2489
Veljko Šantrić Klinika za urologiju, Univerzitetski klinički centar Srbije; Medicinski fakultet, Univerzitet u Beogradu https://orcid.org/0000-0003-3235-9029
Uroš Babić Klinika za urologiju, Univerzitetski klinički centar Srbije; Medicinski fakultet, Univerzitet u Beogradu https://orcid.org/0000-0002-0673-9207

DOI: https://doi.org/10.5937/smclk7-64882

Ključne reči: fraktura penisa, povreda uretre, urgentno urološko stanje, hitno hirurško zbrinjavanje

Sažetak

Uvod: Fraktura penisa predstavlja retko urgentno urološko stanje koje nastaje tokom povrede penisa u erekciji, najčešće tokom seksualnog odnosa. U 10%-21% slučajeva, fraktura penisa je udružena sa povredom uretre. Dijagnoza se najčešće postavlja kliničkim pregledom, ali su dopunske dijagnostičke metode korisne u proceni mesta rupture kavernoznih tela i otkrivanju povrede uretre. Ovo urgentno stanje zahteva hitno hirurško zbrinjavanje jer je odlaganje povezano sa lošijim ishodima.

Prikaz slučaja: Muškarac star 43 godine javio se u Urgentni centar Univerzitetskog kliničkog centra Srbije, zbog povrede penisa u erekciji tokom seksualnog odnosa, sa anamnestičkim podacima da je osetio bol i čuo zvuk „pucanja”, nakon čega je došlo do nagle detumescencije penisa i pojave hematoma penisa, kao i pojave krvi tokom mokrenja. Kliničkim pregledom uspostavljena je sumnja na frakturu penisa. Ultrazvučnim pregledom je utvrđena ruptura tunike albuginee (lat. tunica albuginea) desnog kavernoznog tela, a retrogradnom uretrocistografijom utvrđena je ruptura penilne uretre. Pacijent je iste večeri operisan. Kao hirurški pristup, primenjena je središnja penoskrotalna incizija, zatim je učinjena sutura desnog kavernoznog tela i penilne uretre preko nežno plasiranog urinarnog katetera. Postoperativni tok je bio uredan. Pacijent je na kontrolnim pregledima naveo uredne erekcije, uredno mokrenje i zadovoljstvo izgledom penisa.

Zaključak: Fraktura penisa je retko urgentno urološko stanje, relativno retko udruženo sa lezijom uretre. Prikaz našeg slučaja ukazuje na značaj inicijalne ultrazvučne i radiografske dijagnostike. U slučaju kada je mesto povrede preoperativno prisutno, ventralna penoskrotalna incizija može biti pogodan hirurški pristup. Pravovremeno prepoznavanje i hirurško lečenje frakture penisa udružene sa lezijom uretre daje odlične funkcionalne rezultate.

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