CASE 13598 Published on 20.07.2016

Penile trauma - Corpus spongiosum tear


Uroradiology & genital male imaging

Case Type

Clinical Cases


Prat-Matifoll JA, Ng Wong YK, Juárez M, Delgado I, Hernández Morales D, Mast R, Quiroga S

Vall Hebrón Hospital,
Institut Català De La Salut,
Passeig Vall Hebrón 116-119
08035 Barcelona, Spain;

51 years, male

Area of Interest Genital / Reproductive system male, Abdominal wall, Anatomy, Abdomen, Interventional vascular ; Imaging Technique CT, Percutaneous, Lymphography, Digital radiography, Catheter arteriography
Clinical History
50-year-old patient came to the emergency room with an active urethral bleeding, probably related to a direct trauma, although other mechanisms could not be ruled out (i.e. urethral sticks).
Imaging Findings
- CT findings:

On arterial phase, we observed contrast extravasation in the penile bulb. Iodinated contrast extended anteriorly within the corpus spongiosum (Fig. 1).

On venous phase, the amount of extravasated contrast increased and changed its morphology, suggesting an active bleeding (Fig. 2).

On coronal view, a significant enlargement of corpus spongiosum was observed. This was caused by the active bleeding, which evacuated through the urethra (Fig. 3).

- Angiography:

The tip of the diagnostic catheter was positioned in the left internal iliac artery ostium and after contrast injection, a contrast blush from the internal pudendal artery was observed (Fig. 4a).

Embolisation was performed using absorbable haemostatic gelatin sponge, to avoid complications (erectile dysfunction) (Fig. 4b, Fig. 5). Despite a correct embolisaton, pudendal arteries recanalized and two new contrast blushes were observed, both of them stemming from pudendal arteries (Fig. 6). The use of a liquid embolic agent (Onyx) was required (Fig. 7).

- Antegrade/retrograde cystourethrogram:

A stenosis in membranous urethra was observed (Fig. 8)
-ANATOMY [1, 4]:

The penis is composed of two corpora cavernosa and a corpus spongiosum.
Corpora cavernosa consist of venous sinusoids surrounded by the tunica albuginea (one of the strongest fascias of the body).
Corpus spongiosum surrounds the urethra and expands anteriorly to form the gland of the penis.


The internal pudendal artery has 3 main branches:
1. Dorsal artery, which supplies the glans penis and skin.
2. Cavernosal artery which is located in the centre of each corpus cavernosum.
3. Bulbo-urethral artery which supplies the urethral bulb and posterior corpus spongiosum.

-BACKGROUND [1, 2, 4]

There are 4 main lesions in penile traumas:

1- Penile fracture is a traumatic rupture of the albuginea and corpora cavernosa of an erect penis. Urethra and corpus spongiosum may also be affected.

2- Priapism is a prolonged penile erection not associated with sexual desire.
Priapism is categorized as low flow (hypercoagulability, sickle cell disease, or medication) or high flow (arterial trauma). Low flow priapism is an emergency, it could lead to irreversible ischaemic changes and erectile dysfunction.

3- Intracavernosal haematomas: They are usually bilateral and result from injury to the cavernosal tissue in the absence of complete tunical disruption.

4- Traumatic avulsion of the dorsal penile vessels: Thrombosis of the superficial and deep dorsal penile veins is a urologic emergency. Detumescence of the penis does not occur because tunica albuginea is not affected (key point to differentiate this case from penile fractures).

5- Others: Penile amputation, penetrating injuries and soft tissue injuries.


Our case is an example of active bleeding stemming from the bulbourethral artery and caused by a corpus spongiosum tear (penile bulb) (Fig.1). This is an atypical case of penile trauma, involving corpus spongiosum (corpus spongiosum tear) and urethra (Fig. 3). The mechanism of injury unknown.


Four weeks after bilateral embolisation, the patient had normal erections. However, he referred changes in the volume and frequency of urination. An anterograde/retrograde cystography was performed to rule-out urethral injuries. It showed a stenosis in the membranous urethra (Fig. 8).
Anterograde urethrography is advocated in any case of voiding difficulty or haematuria.


There are 4 main lesions in penile traumas: Penile fracture, priapism, intracavernosal haematoma and dorsal penile vessel lesion.

Penile fracture is a rupture of the albuginea and corpora cavernosa of an erect penis.

Less likely penile traumas: Penile amputation, penetrating penile injuries and penile soft tissue injuries.

Anterograde urethrography is advocated in any case of voiding difficulty or haematuria.
Differential Diagnosis List
Penile trauma - Corpus spongiosum tear
Penile fracture
Intracavernosal haematoma
Dorsal penile vessels injury
Final Diagnosis
Penile trauma - Corpus spongiosum tear
Case information
DOI: 10.1594/EURORAD/CASE.13598
ISSN: 1563-4086