Penile Trauma and Hematuria in a 48-Year-Old Man

D. Brady Pregerson, MD

Disclosures

September 15, 2015

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 48-year-old man presents to the emergency department (ED) after an incident in which he tripped while working in the bed of his pickup truck and fell forward onto a log. He suffered a direct blow to his perineum and penis, which initially resulted in intense pain that lasted for approximately 5-10 minutes. The pain subsequently subsided, and he continued his activity without discomfort; however, when he attempted to urinate after his work was complete, the patient experienced severe, burning pain in his penis and noted a large amount of hematuria. His symptoms persisted with each episode of urination over the next few hours, leading him to seek evaluation in the ED.

Upon presentation, the patient reports no pain while at rest. He denies any trauma to his flank or abdomen as a result of the fall. He denies any abdominal pain, nausea or vomiting, difficulty or pain while walking, and scrotal swelling or bruising. He has no significant medical history and does not take any medications.

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