NEJM临床图片：阴茎折断
42岁男性患者，平素健康，因性交期间出现突发性阴茎疼痛到急诊科求医。患者曾在阴茎勃起期间意外撞击伴侣的外阴部，听到折断的声音，并感受到尿道迅速充血。随后阴茎的勃起状态消退，并出现严重疼痛。
阴茎折断是指白膜的断裂，该处组织是阴茎海绵体外部的一层封闭性纤维膜，是维持勃起的重要组织结构。白膜断裂可导致海绵体周围出血并引起血肿。可见典型的“茄子样畸形”，即阴茎肿胀、变色，并偏向白膜断裂处的对侧。如果损伤同时涉及尿道口，则血液会从尿道口流出。
基于其临床表现，患者被迅速送入急诊手术室接受修补术。患者术后病情平稳，并于术后第二天早晨出院。阴茎折断的后遗症包括毁损性瘢痕形成引起的勃起功能障碍、阴茎弯曲，以及潜在的神经受损。患者在手术后的3个月和6个月接受复查，已经可以重新勃起，无显著的瘢痕形成或阴茎弯曲。
A healthy 42-year-old man presented to the emergency department after the acute onset of penile pain during sexual intercourse. The erect penis had inadvertently collided with his partner's perineum. He heard a snap, noticed a rush of blood from the meatus, had immediate detumescence, and had severe pain. The penile “fracture” refers to a tear in the tunica albuginea, the watertight fibrous outer sheath of the corpora cavernosa that is responsible for maintaining the structural integrity of an erection. Disruption of the tunica results in a loss of blood outside the corpora, causing a hematoma. The classic eggplant deformity (swelling, discoloration, and deviation away from the defect in the tunica) can be seen. If the fracture involves the urethra, blood will extravasate through the urethra. On the basis of the clinical presentation, the patient was taken to the operating room for emergency repair. The patient had an uneventful postoperative course and was discharged from the hospital the morning after surgery. Sequelae of penile fracture include erectile dysfunction due to disfiguring plaque formation, penile curvature, and possible nerve injury. The patient was seen 3 months and 6 months after surgery and had regained erectile function without appreciable plaque formation or penile curvature.
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