[Comparison of Ultrasound and Magnetic Resonance Imaging in Diagnosing a Penile Fracture: A Retrospective Data Analysis].

Abstract

A "penile fracture" is a rare urological emergency. According to international literature, a clinical diagnosis is considered sufficient if the patient's history and clinical appearance are characteristic. Imaging modalities such as sonography, cavernosography, and MRI are appropriate diagnostic tools. Sonography is a fast, inexpensive and widely used imaging method; however, MRI offers a higher resolution. The current literature recommends timely surgical treatment.This is a retrospective, single-centre cohort study including all patients who presented at the University Hospital of Lübeck with a suspected penile fracture between 01 January 2018 and 30 September 2024.Sixteen patients were analysed. Eight patients presented on the day the trauma occurred.MRI morphology confirmed a rupture of the corpora cavernosa in 13 of 16 patients. The suspicion was not confirmed in 3 patients. Sonographic and MRI morphological findings correlated in 11 patients, sonography was false negative in 2 patients and false positive in 2 others. In 1 patient, both sonography and MRI yielded inconclusive results.Clinically, a deviation of the penis was seen in about 23% of fractures, 92% showed a haematoma, and about 23% of the patients with a rupture reported that they had heard a "cracking sound".The diagnosis can be established clinically, sonographically, and via MRI. Sonography is suitable for the initial assessment of whether there is an interruption in the continuity of the tuniga albuginea. In the hands of experienced examiners, this may be sufficient to precisely localize the defect. However, in rare cases where sonographic expertise is limited, MRI serves as a more sensitive imaging technique that can rule out differential diagnoses and localize defects.In summary, according to the literature, an MRI is helpful for treatment planning, but not necessary for surgical treatment. With a correlation of sonography and MRI in 69% of the cases we examined, sonography is a sufficient diagnostic tool for determining the indication for surgery. Based on our data, we consider a positive sonography to be sufficient for the initiation of further therapy. However, based on our evaluation, we would recommend MRI in cases of negative ultrasound findings with persistent clinical suspicion.