The role of ultrasound (US) and magnetic resonance imaging (MRI) in penile fracture mapping for modified surgical repair

To determine the accuracy of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnosis of penile fracture and preoperative mapping for modified surgical repair. Twenty-five consecutive patients were included in the study prospectively over 29 months (from February 2014 to June 2016). US examination and MRI were performed on all patients and interpreted by two expert radiologists independently. The location of the defect in tunica albuginea was mapped onto a designed scheme preoperatively using each imaging modality. The detection rate, as well as agreement between preoperative radiologic mapping and surgical outcomes, was determined for each modality. The mean age of the patients was 28 +/- 7.5 years. The most common etiology was intercourse (88%). The most common location of tunica albuginea rupture was mid-shaft of the penis (60%), and the mean length of tunica defects in their greatest dimension was 13.5 +/- 3.95 mm. All patients had associated hematoma, but no urethral injury was detected. The detection rate of US and MRI was 88 and 100%, respectively. US mapped the tear location correctly in 18 patients [61 out of 75 items (81%); kappa = 0.66], while MRI mapped it precisely in 23 patients [73 out of 75 items (97%); kappa = 0.95]. Both modalities are extremely helpful for the diagnosis of penile fracture. Considering the cost-efficiency and accessibility of ultrasonography, US is recommended as the first-line tool for both diagnosis and preoperative mapping. MRI may be used as a complementary study in the patients for whom US fails to visualize or precisely define the tunica defect.