Acute penile pain

Causes

• Penile fracture.
• Paraphimosis.
• Infections (balanitis, balanoposthitis, herpes).
• Urethritis.
• Urethral stones.
• Foreign bodies.
• Tumors.

Clinical assessment

• Sudden onset, history of trauma.
• Deformity and hematoma (“eggplant deformity” in fracture).
• Inability to reduce the foreskin (paraphimosis).
• Urethral discharge, dysuria.

Diagnosis

• Examination.
• Ultrasonography if fracture or a foreign body is suspected.
• Urethroscopy if stones or strictures are suspected.
• Laboratory tests: urinalysis, culture, STI screening.

Emergency management

• Penile fracture: emergency surgery (repair of the tunica albuginea defect).
• Paraphimosis: reduction (compression, anesthesia, division of the constricting ring).
• Infections: antibiotics, local treatment.
• Stones/foreign bodies: endoscopic removal.

Algorithm